Membership Renewal Application

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Blue Ridge Bernese Mountain Dog Club Membership Renewal Application

BRBMDC Membership Fees are due & payable by January 1 of each year and no later than March 31 of each year. Any membership with unpaid dues after March 31 is deemed lapsed. Membership may be reinstated upon submission of a Reinstatement Request Form, and subsequent approval by the Board.

Please complete the entire form so we may update our club records.

* Indicates required field

Please Select your membership level *

Regular ($20) Family ($30) Associate ($15) Associate Household ($25) Junior ($15)

Notes:

Regular - One adult member in household
Family - Two Regular members in the same household
Associate - A limited membership option for anyone interested in the club, but unable to fully participate
Associate Household - Two Associate Members in same household
Junior - Open to persons 10-17 years of age
Only Regular Members vote/hold office
Payments to BRBMDC for dues or support of its programs are not deductible for tax purposes.

Member 1 *

First

Last

Home Phone *

Mobile Phone Member 1 *

Email Member 1 *

Are you a Bernese Mountain Dog Club of America (BMDCA) Member? - Member 1 *

Yes No

Please update the fields below with any new information. If nothing has changed, there is no need to fill it out.

Member 2 *

First

Last

Mobile Phone Member 2 *

Email Member 2 *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you a BMDCA member? - Member 2 *

Yes No

Please enter information for any additional Family Members: *

Please indicate any areas in which you have an interest in supporting: *

Organizing Club Events Membership Rescue Serving on the board Fundraising & Auction Communications Draft Test Committee

Other *

Please indicate your areas of interest or expertise below. *

Health & Behavior Conformation Draft Agility Rally Obedience Herding Barn Hunt Therapy Scent Work Tracking

Dog Information (Optional)

How many Bernese do you currently have? *

Kennel Name *

Registered Name - Dog 1 *

Call Name - Dog 1 *

Breeder - Dog 1 *

Berner-Garde ID - Dog 1 *

Registered Name- Dog 2 *

Breeder - Dog 2 *

Call Name - Dog 2 *

Berner-Garde ID - Dog 2 *

Please enter information for any additional dogs in comment box below. *

I, the undersigned, (by clicking the SUBMIT button below) hereby apply for membership renewal in the Blue Ridge Bernese Mountain Dog Club and hereby agree to abide by the Constitution and Bylaws and Code of Conduct of the Club, the Bernese Mountain Dog Club of America and the American Kennel Club now and hereafter made.

Upon Clicking the submit button, you will be presented with membership dues payment options.

Submit

(Renewal Form 10.2017)