Membership Renewal Form

In order to keep our records up to date please fill out the following information so that we have accurate information.

Kennel Name: ________________________________________________

Name: ­­­­­­­­_______________________________________________________

Address: _____________________________________________________

City: _____________________   State: __________   Zip:_____________

Best Phone Number to Contact you: ______________________________

Do you send/receive text messages? YES            NO

Are you on Facebook? YES            NO

Email Address: _______________________________________________

Do you prefer your newsletter via email or paper copy? _______________

Birthday (Optional): ______________________________

What year did you join CVGRC? _________________________________

What activities are you most interested in with your dogs?

Conformation               Obedience       Agility            Field Work                        Breeding

Please check (X) the events that you are willing to help out with:

_____ May – Puppy Match – Sunday, May 7th

_____ June – Agility Trial – Friday-Sunday, June 2-4

_____ June – Summer Specialty, New Castle, PA- Thursday-Friday, June 22-23rd

_____June – Hunt Test: at Hambden – Saturday-Sunday – June 11th-12th

_____August – Agility Trial – Aug. 13-14th                                

_____September – WC/WCX – September 3


Are there guest speakers, topics or activities that you would like to see us cover at meetings? (If you need more room please list on the back of this form)

Membership renewal Fee is $15.00 per member

Please Return no later than January 31, 2017

Please Mail your Completed Form and Checks made payable to CVGRC:

For the address to forward your membership dues to please contact Amy Harmon at