AHTA - Membership Renewal Application

Single Membership:	____ (enclose $15.00)
Family Membership:	____ (enclose $20.00)
Honorary Membership:	____ (Non-voting, enclose $10.00 by money order)

Name: ____________________
Family members (if family membership): _______________________________________________________________

Address: ____________________________________
Address (Line 2): ______________________________
City: _________________________ State: __ Zip Code: __________

Telephone: ______________

Current Email address: __________________________

Additional Questions or Comments:


Signature: ____________________ Date: __________

Make checks payable to: American Hairless Terrier Association

Send renewal with payment to:		American Hairless Terrier Association c/o Melissa Kidd 4509 Pete Lane Trinity, NC 27370