New Member	Newsletter ONLY in PDF

Application Received Date	Time	Fees Received Date	Time	Membership active upon receipt of the application and membership fees.

Renewing Member

Lifetime Member

Application for Membership

(Please print clearly in black ink)

DUES MUST BE PAID IN U.S. CURRENCY

INDIVIDUAL MEMBERSHIP (An individual membership consists of one adult 18 years and older at the start of the pull season).

Name	Date of Birth

$40.00	Check #	Cash $	PayPal #

FAMILY MEMBERSHIP (A family unit consisting of not more than two adult members and the minor children of the adult/s at the start of the pull season).

Name of Primary Adult	Date of Birth

Spouse/Significant Other	Date of Birth

Child/ren	Date of Birth

Child/ren	Date of Birth

$45.00	Check #	Cash $	PayPal #

JUNIOR MEMBERSHIP (A member under the age of 18 years at the start of the pull season and has a sponsor who is a member of the IWPA in good standing).

Name	Date of Birth

Sponsor Name	Signature

$15.00	Check #	Cash $	PayPal #

Mailing Address

City State Zip Country

Phone ( ) - E-Mail

For returned checks the IWPA will charge the check writer for cost incurred or a MINUMUM of $25.00

Please submit Application with fees (make checks payable to the IWPA, do not mail cash) or PayPal iwpa.net/forms.html to:

Mary Felice

300 Pine Street

LaSalle, CO 80645

Cell: 970-396-1522

Email: FELIWPA7073@gmail.com

Membership Agreement: Abusive or inhumane treatment of a dog shall be strictly prohibited and shall be cause for disqualification. I consent that unannounced random drug testing of any or all dogs can occur at the approval of the IWPA Board of Directors.

/s/ Signature Date

06/24 RR