Membership Application

BARC Membership Application
Name

First NameLast Name
Other Household Members Names
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How many dogs do you own?
What are their names, breed and age?
Do you have titles on your dogs? Please let us know!
Have you belonged or do you belong to any other dog clubs? Please share.
What would you like to be able to contribute to the club?
Why do you want to join the BARC Agility Club?
I/we agree to promote and uphold responsible dog ownership. I agree to conduct myself
in a manner that shows good sportsmanship in any aspect of dog agility and will give the public
the perception that agility is a fun and enthusiastic sport that everyone can participate in. It is
my understanding that as a club member, I am expected to volunteer to help at club events
whenever possible.
Who are your sponsors/club members you know?
Date

MonthDayYear
Date
Signature
Membership Options
prevnext( X )
Individual Membership
$15.00



Household Membership
$22.50



Junior Membership (under 18)
$7.50



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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BARC Membership Application