PWDSNE Membership Form
Annual dues should be submitted by February 28.
Dues are $20 for an Individual or $25 for a family.
Please make checks payable to: PWDsNE
Please fill out this form, then Print a screen shot of name and address and mail a copy and your check to:
Karen Kirby Ash, 7 Stuart Circle, Moultonboro, NH 03254-4756
Please send an email to
that you have completed this form and mailed payment.
Any information given on this application is considered private and will be used solely
by the club for the express purpose of membership consideration into this club.
Please do not forget to hit SUBMIT button at end of form when done.
Enter Your Name:
Enter Your Address:
123 Mail St, Anywhere, State, 00000
What Activities Do You Participate In Currently?
Check all that apply
Enter Your Cell Phone Number:
Enter Your Home Phone Number
Enter Your Email Address:
Why do you want to join our club?
Please tell us about your current dogs
What other dog organizations do you or have you belonged to?
I understand that upon acceptance into the the regional PWDsNE club I will adhere to the by-laws of thie club as voted by the membership.
Individual or Family Membership
Please indicate if this is an individual or family membership. Please include additional members names on form.
Additional Family Member(s) Name(s) and Age(s) if under 18.
Please provide the name of all additional family members and include ages for under 18.
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