NESDCA Renewal Application

NESDCA uses the information in this application to determine your qualifications for membership and to ensure that NESDCA will contain a fair balance of interests. NESDCA will not use this information for any other purpose than the above. Please provide us with as much information as you feel will assist us in the process.

We accept PayPalUse this form only if you want to apply and pay for your membership online. Payments are accepted through PayPal.

If you prefer to mail in your payment  please download and fill out the renewal application HERE.
Name of Individual
Title
Employer
Mailing Address
 
City
State/Province
Country
Zip/Postal Code
Telephone
Fax
Email Address
FEE: Regular is $225.00 annually for 1st membership, $100.00 each additional member.

1. ACTIVE TEAM (S)
 a. List all active teams which you are renewing. Include Handler and canine together

b. Please update any required contact information to include, new numbers, e-mails, contact personal, mailing address etc. that may have changed over the last year.
2.COMMENTS

I agree to abide by the RULES and BY-LAWS and agree to notify the Secretary of the NESDCA of a change in status, including change of employment, organization represented, location or funding source.

I attest that all of the information on this application is true and accurate.
Type your FULL NAME
Today's Date