EVANSVILLE DOG OWNERS GROUP APPLICATION Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *( required for EDOG business only) Address *Address Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDog’s Name / Description *(Please Upload a color, full-body photo of your dog - Required to enable proper ID of each Member dog )Picture of Dog Upload Click or drag a file to this area to upload. INCLUDE THE FOLLOWING WITH THIS COMPLETED APPLICATIONProof of Current Vaccinations ( copy of rabies vaccination certificate and/or Veterinary statement or receipt ) *RabiesBordetellaParvovirusDistemperHeartworm ProductProof of Current Vaccinations ( copy of rabies vaccination certificate and/or Veterinary statement or receipt ) * Click or drag files to this area to upload. You can upload up to 8 files. Membership in Central Bark Park is on an Annual renewal basis. Our Membership year runs April 1 through March 31. Annual dues are $ 42.00 per year, per dog. All members will receive a bill for $42 each April per dog. Refer to the chart below to determine your pro-rated dues, based on the submission date of your Application. ChartMonth Joining January February March April May JuneAmount Due $ 10.50 $ 7.00 $ 3.50 $ 42.00 $ 38.50 $ 35.00Month Joining July August September October November DecemberAmount Due $ 31.50 $ 28.00 $ 24.50 $ 21.00 $ 17.50 $ 14.00INCLUDE a one time $10 Administration fee with your duesDues and Renewals: *Please enter the amoint due from the chart above.Submit
