MPBA DIRECTORY 2024 WEB

WANT TO BE LISTED IN THE DIRECTORY? q YES q NO All members automatically included in directory unless otherwise specified

Membership Application/Renewal Form 2025 *PLEASE PRINT LEGIBLY. MPBA is comprised of members who volunteer their time for offices and services. MPBA will not be responsible for calling or emailing applicants to confirm what is written is correct if not legible.

Name Kennel Name (if applicable) Street Address City

State

Zip

Phone/Cell Email

Website Chapter Dog Breeds Raised (Please separate by comma; please specify toy, mini, or standard if applicable)

PAYMENT INFORMATION

Membership Dues are $40.00

Youth Memberships are FREE!

Memberships are valid from March 1st to March 1st

If paying by check, please make out to Missouri Pet Breeders Association. Forms and checks may be mailed to: MPBA • 313 B West Commercial • Lebanon, MO 65536 Visit us online at www.mpbaonline.org

CREDIT CARD PAYMENTS If paying by credit card, please complete:

Office Use Only: Paid Via: q Check #________ q CC q Cash Date:_____________

Card # Exp. Date

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CVV

Rev. 05/24

2024 MPBA Directory | Page 59

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