Single...........................................................$15.00

Family...........................................................$20.00

(2 adults living in same household)

Affiliate.........................................................$10.00
(non-voting)

Send form to :Debi Taylor, Secr. 3252 Saratoga Road Langley WA 98260

Name(s)________________________________________________Date_____

Address________________________________________City______________

St.________ Zip_________ Ph.#_____________________________________

E-Mail___________________________________ FAX___________________

I/We offer the above information to be true & correct. Understanding that any alterd or falsified information may lead to denial of membership in the NWCSPC. I/We have read, understand and agree to abide by the articles, rules, regulations and ethics of the Northern Washington Chinese Shar Pei Club.
I/We understand that this application will be voted upon by the members of the Northern Washington Chinese Shar Pei Club

Signed___________________________________________________ Date________

What category does your Shar Pei fall under

Pet______ Show______ Obedience______ Rescue______ Agility______ Other___

*************************************************************************************
<Club use only>

Date application received_______ Date dues received______ Check#___________

Application approved______ Denied______ Applicant Advised_________