Buckeye Retriever Club

Membership Renewal Form

NAME: _________________________________________
ADDRESS: ______________________________________
CITY: ___________________________________________
STATE: _________________ ZIP: ____________________
PHONE: HOME (

) ________ CELL (

) ____________

EMAIL ADDRESS: ________________________________

May we give out your contact information to other club
members in the form of a club directory? Yes No

Newsletter & Club Directory

Future Newsletters & Phone Directories will be emailed to club
members, you may opt out to receive these communications by US
Mail?
Yes, I would like email No, please send communications by US Mail

The club holds AKC licensed events each year and members are
expected to work one day at one of these events each year. Working
at an event does not prohibit a member from participating in the
same event.

Dues for 2017 are $90.00

Send this renewal update form with your annual membership
fee made payable to Buckeye Retriever Club to the membership
secretary at the address below.
Buckeye Retriever Club
c/o Bill Skeels
P.O. Box 52
North Bloomfield, OH 44450