Finger Lakes NAVHDA Membership Application


Please print this form using your browser's print command and (Bring to training or Meeting) mail to:
Kim Burkhart, 6597 Fairgrounds Rd., Byron, NY 14422
Make checks payable in U.S. to Finger Lakes NAVHDA


$20.00 Single Local Club Membership

$25.00 Family Local Club Membership



Name__________________________________________________________________

Street__________________________________________________________________

City___________________________ State/Province ______ Postal Code___________

Phone _____-_____-____________ Breed of Dog ______________________________

Name of Dog _______________________________________________________

National Affiliation (Yes/No) _______

E-mail Address ____________________________________________________






Membership Contact: Kim Burkhart (585)548-2847



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