The Chinese Shar-Pei Club of America

Founded 1974

PO Box 780118, Maspeth, NY 11378-0118

Application for Membership

(See Membership Rules)

MEMBERSHIP YEAR-July1 through June 30 of the following year.

(Applications received after March 1 will be enrolled to May 31 of the following year)

Under the Revenue Act of 1987, please be advised that membership fees, dues and contributions to this organization are NOT deductible as charitable donations.

MEMBERSHIP CATEGORIES

(All memberships include The Barker, a bi-monthly magazine)**

_____Indivual (1 vote)-$45

_____Family (2 adults, same household, U.S. only-2 votes)-$50

_____Junior(10-17 YEARS, U.S.ONLY)-$45

_____**(Junior Membership without The Barker-$10)

_____Associate (Canada:U.S. funds, i.e. U.S. certified check, money order or credit card)-$50

_____Associate (Foreign:U.S. funds, i.e. U.S. certified check, money order or credit card)-$60

We accept Master Card and Visa
Fax:(718)424-0918
Email: Membership@cspca.com

_______Check

_______Master Card

_______Visa

Card#_________________________

Exp. Date:____________________

Name:Mr./Mrs./Ms._____________________________________________________________________________________________________

Address:_____________________________________________________________________________________________________________

City:_______________________________________________State:___________________________Zip:____________________________

Telephone:__________________________________________Occupation:______________________________________________________

Date of Birth (Junior only)__________________________________________________________________________________________

We agree to abide by the Articles of Incorporation, By Laws, and Rules and Regulations of the Chinese Shar-Pei Club of America, Inc.

Signature:__________________________________________________________________________Date:____________________________

Signature:__________________________________________________________________________Date:____________________________

ENDORSEMENT OF ADULT APPLICANT OR SPONSOR OF JUNIOR APPLICANT

1.Signature_______________________________________________________________________Date:____________________________

Print Name:______________________________________________________________________________________________________

2.Signature_______________________________________________________________________Date:____________________________

Print Name:______________________________________________________________________________________________________