DWNA Member Application Form

Please print and mail:

DWNA Treasurer

Aaron Kenstler

Box 761

Ansted, WV 25812

I wish become a member \ renewal in the Deutscher Wachtelhund North America Club, Inc.:  As a member will be obligated to follow the DWNA Charter and Breeding Regulations.

 

Surname: _________________________   First name: ________________________

Address: __________________________  City : _____________________________

State: ____________________________   Zip Code: ________________ 

Date of birth:______________________   Occupation:______________________

Home Phone: ______________________  Work Phone: ______________________

Cell Phone: ________________________ E-mail:___________________________

Please, check and sign:

Student, trainee
Family membership is applied in the name of the first member
Initial and annual membership fee $30.00.  Dues are due each January.  Resignations must be writing.
Membership Renewal
I agree with the storage of this personal data in the DWNA\VDW records.

 

Signature: __________________________________  Date: ___________________