VIRGINIA POLICE WORK DOG ASSOCIATION   
MEMBERSHIP RENEWAL FORM  

DATE OF RENEWAL: TYPE OF RENEWAL: REGULAR: ASSOCIATE:  

MEMBER’S NAME:  

MEMBERS ADDRESS:   

CITY: STATE:   ZIP:

MEMBERS PHONE NUMBER: (AREA CODE):(NUMBER):  

MEMBERS DEPARTMENT:  

DEPARTMENTS ADDRESS:  

DEPARTMENT PHONE NUMBER: (AREA CODE): (NUMBER) 

ADDITIONAL INFORMATION YOU WISH TO UPDATE:


 E-MAIL ADDRESS:

(Associate Members-Must be sponsored by a regular member each year and they must include a copy of a current criminal history check.)

*SPECIAL NOTE *             

IF THE RENEWAL FEE IS RECEIVED NO LATER THAN SEPTEMBER 1^ST, OF THE YEAR DUE,  THE REGULAR RENEWAL FEE IS $20.00  
IF THE RENEWAL FEE IS RECEIVED AFTER SEPTEMBER 1^ST, OF THE YEAR DUE, A $5.00 LATE FEE WILL BE ADDED TO THE RENEWAL FEE . ($20.00 + $5.00 = $25.00)  
IF THE RENEWAL MEMBERSHIP DUES ARE NOT RECEIVED BY DECEMBER 31^ST, OF THE YEAR DUE,  THE MEMBER WILL BE DROPPED FROM THE MEMBERSHIP LIST. THIS ALSO MEANS THAT YOUR MEMBERSHIP DATE JOINED WILL BEGIN FOR THE FOLLOWING YEAR IF THEY ARE NOT PAID FOR THAT YEAR. 

RETURN TO :HARRY E. PHERSON, JR. - 191 WALNUT LANE - KING WILLIAM, VA., 23086