Membership Intake Form

Membership Form

Inland Empire NAVHDA is pleased to welcome you and your dog. Please complete this form to be added to the e-mail list. If you are a new member, a board member will reach out to you to answer any questions you may have. It is a requirement that you become an International member to join the Chapter. NAVHDA International membership forms are available on the NAVHDA International website (www.navhda.org).

First Name

Last Name

NAVHDA International Member Number (you can look up your number here: https://www.navhda.org/member-roster/)

NAVHDA International Membership Expiration Date? (MM/DD/YYYY)

Phone (double check!)

Dog's Call Name(s)

Dog's NAVHDA Registration Number(s), if not yet registered put N/A. (If you plan on testing, you will need to have your dog registered with NAVHDA) Dogs Registration Number can be found NAVHDA.org, Menu, Registry, Search Database

Breed of Dog(s)

Select an item ($)

Individual Membership - $25

Family Membership - $35

You will be directed to payment after submitting.

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code