Membership Application

First Name (*)

must contain only a-z,A-Z characters
Last Name (*)

must contain only a-z,A-Z characters
Address (*)

must contain only 0-9,a-z,A-Z characters
Telephone (*)

is not a number. example: xxx-xxx-xxxx

Email Address (*)

is not a valid e-mail address.
Date of Birth (*)

example xx/xx/xxxx

Gender (*)
MF
must contain only a-z,A-Z characters
If renewing membership, enter ID number, if not previously Chapter 310 identify which Chapter

example: ID number xxxxx, Chapter number xxx


If there are any questions about your eligibility or this application call 734-439-1606 after 5 pm or email at dogman2@gmail.com