PDX PAH MEMBERSHIP FORM

Membership Type *

New Membership - $20

Annual Renewal - $20

Legal Name *

Legal Name

First Name

Last Name

Pet or Scene Name

Date of Birth *

Date of Birth

YYYY

Phone Number *

Phone Number

(###)

###

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Email Address *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Information

Emergency Contact *

Emergency Contact

First Name

Last Name

Emergency Contact Phone Number *

Emergency Contact Phone Number

(###)

###

####

Relation to Member *

Participation & Membership

Participation: Portland Pets and Handlers is a social organization that encourages active participation from its members to make sure every event is safe, fun, and welcoming to all who wish to join. Please come to our board meetings or contact one of our board members for more information on volunteering. Contact: Portland Pets and Handlers will only use your email to send you information related to renewal, when your membership is about to expire, and a monthly email which details upcoming events.

I certify that I am 21 years or older, agree and consent to membership with the Portland Pets and Handlers (PDX PAH), agree to and abide by the bylaws and rules of PDX PAH, a copy of which I have been advised can be provided upon written request. I understand that my personal information on this application shall be kept by the organization for its own use and will not be released to outside parties without my consent. I agree that I will not, at any time, hold PDX PAH, its officers, members, or other entities associated with PDX PAH liable for any injury physical or otherwise, which my property or I may sustain as a result of my involvement with PDX PAH, which includes any harm done at any gathering of PDX PAH members, planned or spontaneous, including at the homes of PDX PAH members. I assume total responsibility for my personal actions, and understand that the BOARD of PDX PAH reserves the right by simple majority to decide now or hereafter to refuse or terminate my membership with or without cause. I am aware that group photos and/or video may be taken at our events. I understand that contributions or gifts, including membership dues, are not tax deductible for federal income tax purposes. PDX PAH shall not discriminate on the bases of gender, gender expression, sexual orientation, national origin, disability, race, religion, or species identity.

Email Opt In or Opt Out *

By checking this box, I wish to receive the monthly newsletter about events

By checking this box, I wish to NOT receive the monthly newsletter about events