Membership Form

Which membership are you applying for?*

First Name*

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Email*

Enter Email Confirm Email

Breed of Dog

NAVHDA International #:*

You must be a member of the international org, if you wish to join a local chapter.

When did you last pay your dues to NAVHDA International?*

Which membership level would you like?*

Make check payable to: Hudson Valley Chapter of NAVHDA. Or HVNAVHDA Mail To: Debbie Field 4354 Glenwood Drive Emmaus,PA 18049

Optional Questions

Are you testing a dog this year?

When do you intend to test?

What level of test will you run?

Have you attended an HV NAVHDA clinic before?

If you are new to the chapter, do you know any of our members? If yes, please list

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Name

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