Membership Form

Name

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please include me in the USBCHA members' mailing list

Yes
No

Year you would like membership to take effect

Membership expires December 31 of the current year regardless of when membership is paid. Select either current year or select next year to begin membership beginning January 1.

Membership Status

Please select the action needed.

Has any of your contact information changed since your last renewal?

No changes
New eMail
New Phone Number
New Address

Choose all that apply.

Payment Method

Name of Officer or Director of USBCHA given fee

Must be given prior to run

PayPal Account

If you are paying via PayPal and the namel of the PayPal account you are using is different than the name or email address above, please enter the name of the PayPal account you are using.

Sanctioned Trial Name

List one nursery or open sanctioned trial in which you competed within the past 2 years

Sanctioned Trial Date

Please enter the name and dates of a USBCHA sanctioned Open or Nursery trial you have competed in the past two years. You must put the name and date of a sanctioned trial within the last two years to apply for General Annual or General Lifetime memberships.

Membership Type

The higher amounts are due to service charges that PayPal levies for processing online payments. Must be eligible for general membership for life membership. Include date and name of open or nursery trial you competed in most recently.

Membership Associate

The higher amounts are due to service charges that PayPal levies for processing online payments. Must be eligible for general membership for life membership. Include date and name of open or nursery trial you competed in most recently.

Membership Type

Must be eligible for General membership in order to have Lifetime membership. Please submit name and date of recent open or nursery trial you competed in for general membership

Membership Type Associate

Must be eligible for General membership in order to have Lifetime membership. Please submit name and date of recent open or nursery trial you competed in for general membership

To complete payment by check, Put your name in memo section of check and end your check to:
USBCHA Secretary
1556 Harding St
Enumclaw, WA 98022

Funds must be in US Currency. Membership will take effect on the postmark date.

Total Amount

$0.00

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