Membership Renewal Application

Your Name (required):

Your Email (required):

Mailing Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Dog(s)' Name and Breed:

Membership Renewals Are Due in January!

  • Dues are $20 for an Individual Membership and $25 for a **Family Membership.
  • Expiration: December 31 of the current calendar year.

**Family Membership Names:

Amount you will be paying:

If you have any questions about membership, please call Julie at 623-670-3000

Make checks payable to: Jumping Chollas Agility Club, Inc.

Mail membership form with check to:
JCAC-Membership
c/o Julie Grant
1515 West Encanto Blvd
Phoenix, AZ 85007