DDTC MEMBERSHIP ANNUAL RENEWAL FORM

(PLEASE COMPLETE & MAIL EACH YEAR BEFORE JUNE 1)

Membership Dues are NOT tax deductible

Last Name / First Name
Other Family Members (for Family memberships only): / Relationship to Member:
It is okay to share my personal information with other members (such as phone number, email address, etc.)

CONTACT INFORMATION

Street / City / State / Zip
Email Address:
Primary Phone # : / Alternate Phone #:
Breed of Dog(s):
ANNUAL DUES (Please Select Type of Membership)
Type of Membership / Due June 1 / After June 1 / Amount Enclosed
Single / $35.00 / $40.00
Family* / $40.00 / $45.00
*A Family membership includes husband, wife, single parent/guardian or two adults residing at the same address, and their dependent children.
Sr. Citizen** Single / $25.00 / $30.00
Sr. Citizen** Family / $30.00 / $35.00
**If this is the first time you are claiming Senior Citizen status, please include picture ID proof of age (60+).

After August 1, anyone who has not paid their dues will be dropped from the Club roles. If you wish to resign in good standing, please send a letter of resignation to the Corresponding Secretary with your reasons for resigning. Thank You!

Mail your completed renewal form, along with your check/money order made payable to DDTC, to:

Susanne McKee

1608 Laudermilch Road

Palmyra, PA 17078

The Club always needs Volunteers. Earn credit hours by volunteering at Agility/Obedience Show-N-Go matches, & Agility Obedience trials. Please list Club activities in which you would like to become involved, or give us ideas that the Club may want to pursue:

Rev. 04/2016