Doberman Pinscher Alliance of America
MEMBERSHIP APPLICATION
[ ] New Membership [ ] Renewal
NAME:_____________________________________________Additional Applicant (s):______________
ADDRESS:____________________________________________________________________________
CITY:____________________________________STATE:____________ZIP:______________________
PHONE:________________________________E-mail:_________________________________________
Website (not required):___________________________________________________________________
I/we are applying for (check one):
____-INDIVIDUAL MEMBERSHIP $25.00 per year
____-FAMILY MEMBERSHIP $35.00 per year
Logo Merchandise & Weight:
__T-shirts - $16.00 each – ($1.50 extra for 2XL) – ($3.00 extra for 3XL)
__Sweat Shirts - $25.00 each – ($2.00 extra for 2XL) – ($4.00 extra for 3XL)
SIZE: __S __M __L __XL __2XL __3XL
T-shirt/Sweat Shirt colors: ____Grey, ____Ecru, ____White
__Mouse Pad - $7.00
__Tote Bag - $6.50 (Ecru only)
__Doggie Bandana - $5.00 (White only)
__Can Wrap - $5.00 (White only)
__Mug - $7.00 (White only)
__Cap - $10.00 White (Please specify color of bill __Red, __Blue, __Green, __Black)
Shipping and handling by weight:
Up to 1 pound $3.50, 1 to 2 pounds $3.95, 2 to 3 pounds $5.15, 3 to 4 pounds $6.35, 4 to 5 pounds $7.55
Weight of items:
T-shirt 8oz, Sweat shirt 14oz, Mouse pad 6oz, Tote Bag 4oz, Doggie Bandana 1oz, Can Wrap 3oz, Mug 15oz,
Cap 3oz
Membership Amount: __________
Merchandise Amount: __________
Shipping & Handling: __________
Total Amount Enclosed: __________
Do you currently own a white or white factor Doberman? Y___ N___
If not, do you plan to own one in the future? Y___ N___
Can you help with the rescue efforts either by being a foster home? Y__ N__; or as contributor? Y__ N__
If yes to either, please explain:
_______________________________________________________________________
Please list your dog interests (conformation, obedience dog shows, therapy work, tracking, fly ball, ect.):
_______________________________________________________________________
Please list other interest that you would bring to our Club if elected to membership:
_______________________________________________________________________
Would you like your name and email address listed in the newsletter for breeder referral purposes? Y___ N___
Send completed form and fees to:
DPAA Treasurer
16741 ST Rd 148
Aurora, IN 47001
Please make checks payable to: Doberman Pinscher Alliance of America
Signature:_________________________________ Date____________________
