Membership Data Form

Membership Data Form

This form can be used to update membership information, renew membership or join the CSPCA.
It can be used to update, renew or sign up for the Breeders Directory in the Barker and on the website.
This form can be processed on line, faxed to the fax number below
or printed and mailed to the address below

What is this form being submitted for?	other explain
Name(s)
Address
City		State			Zip
Address if outside of USA
Type of membership			Under the Revenue Act of 1987, please be advised that membership fees, dues and contributions to this organization are NOT deductible as charitable donations.
If a junior membership please indicate date of birth
Please consider contributing to the CSPCA Rescue Fund, please indicate amount Please consider contributing to the Charitable Trust Fund, please indicate amount
Email address				Phone

Payment Type	If choosing to pay via PayPal, there is a link available after you click submit	Card #
		Exp Date 2 digit Mon 2 digit Year
By submitting this form via electronic means the names listed as signature above agree to abide by the Articles of Incorporation, By-Laws, Rules and Regulations and Code of Ethics of the Chinese Shar-Pei Club of America, Inc
Member Signature
2nd Member Signature (if family)

The Chinese Shar-Pei Club of America, Inc - Founded 1974
Membership Secretary
33853 SE Doyle Rd, Estacada, OR 97023
E-mail: info@cspca.com / Fax 888 447 5352 / Ph 503 630 3422

PLEASE do not call early, we are on Pacific time.
Call between 9-6 Pacific Time