Membership Application

MEMBERSHIP APPLICATION  

 

OFFICERS:                   President                     Chuck Hagan

Vice President              Char Givens

Secretary                      Mary Kay Biddle

Treasurer                     Rob Pogue

Board Members:          Bill Brown

                                                Rick Doverspike

Todd Rittko

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Date                                   _                                                      Phone                                  _

 

Name                                                              _                          Sponsor:   __________________

 

Street                                                                _                          E-mail Address:____________________

 

City                                                                    _

 

State    _         Zip Code                  _

 

Breed of Dog                              _                                               Number of Dogs                  _

 

Dog’s Level of Achievement:                                                        Owners Level of Handling:

Puppy               _.                                                                     Novice              _.

Started             _.                                                                     Beginner           _

Intermediate      _.                                                                     Moderate          _

Senior               _.                                                                     Experienced      _

 

I have received ____   or applied _____ for PA Child Abuse History Clearance.*

 

Type of Membership:                                            Amount Enclosed:

Individual                                                          $15.00          .

Family                                                              $25.00          .

Junior (under 18)                                               $ 5.00          .

 

Referred by                                                                     _

 

Please mail completed application and membership dues to:

Rob Pogue, Treasurer

302 Buckingham Road

Pittsburgh, PA 15215

Make checks payable to:   SWPaHRC