Membership Form

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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

No changes
New eMail
New Phone Number
New Address

Choose all that apply.

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 next January 1.

Membership Status *

Please select the action needed.

Payment Method *

Membership Type

Membership Type *

The higher amounts are due to service charges that PayPal levies for processing online payments.

Sanctioned Trial Name and Date

Please enter the name and dates of a USBCHA sanctioned Open or Nursery trial you have competed in the past two years.

To complete payment by check, print the email you will receive upon submission and send along with 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

Comment or Message

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