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

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 *

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. 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.

Total Amount

$ 0.00

Comment or Message

Single Line Text

Share this: