Thank you for choosing to apply for membership with the Plummer Terrier Club.

Please complete the online form, or alternatively download the form below:

This fee will be due the following year after you have become a full member.

Name
First Last
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone
Email
If not eighteen, please state*
Do you agree to abide by the Plummer Terrier clubs rules and regulations which are laid out in the constitution?
Sign Name*
Prefix First Last
By signing I understand that the committee’s word is final, concerning my election to the club.
Date
Date Format: MM slash DD slash YYYY