DPCC Membership Renewal - 2021 Membership YearInstructions Please complete all the fields below, that apply to you, to ensure we have current and correct information.Personal InformationFirst Name *Last Name *Email *Phone Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryAdditional Members - Family/Junior MembershipMember 2 - First Name Member 2 - Last Name Member 3 - First Name Member 3 - Last Name AgreementCode of Ethics *I / We agree to abide by the DPCC Code of Ethics as per my / our original membership application.YesNoBreeder Directory Listing - ONLY Complete if ApplicableUse the same directory listing as last year YesNo (if no, please list changes below)Does not apply to mePlease make changes to my Breeder Directory listing as per below: Kennel Information - ONLY Compelte if ApplicableKennel Name Tattoo Payment - Check all that applyFees / Payment: Single Membership - $30.00Family Membership - $45.00Junior Membership - $10.00Breeder Directory - $20.00Life Member - no feeTotal Payment *Please total up membership and/or directory fees.Payment Options *Etransfer - send to treasurer@dpcc.ca use "membership" as verification wordCheque - Treasurer 12549 226th St Maple Ridge BC V2X 9Z6PayPal - use DPCC Payment/Store page on websiteDoes Not Apply - Life Member VerificationFor security purposes please enter any two digit number. This entry confirms you are not a robot. *Example: 12This box is for spam protection - please leave it blank:
