Pacific Northwest Chapter NAVHDA

Membership Application

Mail to:

PACIFIC NW CHAPTER NAVHDA

41900 SE KLEINSMITH RD

SANDY, OR 97055-8635

_____$25.00 PNWC Household Membership

Note that dues for NAVHDA International are in addition to chapter dues.

_____$10.00 PNWC Junior Membership (under 18 years of age

Name__________________________________________________________________

Street__________________________________________________________________

City___________________________ State/Province ______ Postal Code___________

Phone _____-_____-____________ Breed(s) of Dog ______________________________

E-mail address: _______________________@__________________________

I am an International member (circle one) Yes (Number: _____________) No

If Yes, please enter the six-digit membership number from in front of the expiration date on the mailing address of "Versatile Hunting Dog magazine:

If "No," please complete application as international member of NAVHDA and submit along with this form.

(International membership not required for PNWC junior members.

How did you hear about our chapter? (Can we thank somebody for the referral?)

Please tell us about yourself and your involvement with versatile hunting dogs: