| First Name | |
| Last Name | |
| Address | |
| Your city | |
| State | |
| Postal Code | |
| Country | |
| Email address | |
| Telephone (Day) | |
| Telephone (Evening) | |
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| Standard | |
| Miniature | |
| Toy | |
| Club Affiliations | |
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| What UPBA activities are you interested in volunteering for? Check all that apply! |
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| Education/Health Committee | |
| Fund-Raising Committee | |
| Performance Committee | |
| Judging/Stewarding | |
| Membership/Publicity Committee | |
| Newsletter | |
| Show Committee | |
| Web Site Committee | |
| Other | |
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| Please tell us about your prior club experience (e.g. committees, judging, newsletter). |
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| Club Experience | |
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| Please tell us who (if anyone) invited you to join UPBA? |
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| What dog activities do you participate in? Check all that apply! |
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| Agility | |
| Fly-Ball | |
| Obedience | |
| Sledding | |
| Assistance Dog | |
| Freestyle | |
| Personal Protection | |
| Therapy | |
| Conformation | |
| Herding | |
| Scootering | |
| Tracking | |
| Disk Dog | |
| Hunting | |
| Search & Rescue | |
| Weight-Pull | |
| Field Trials | |
| Lure-Coursing | |
| Skijoring | |
| Dock-Jumping | |
| Other | |
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| In what areas have you earned UKC titles? Check all that apply! |
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| Agility | |
| Conformation | |
| Obedience | |
| Weight Pull | |
| Dog Sport | |
| Dock-Jumping | |
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Membership Type:
Individual: (1 adult 18 or over) $20.00 or $20.91 if using PayPal.
Junior: (1 youth under 18) $1.00 or $1.33 if using PayPal.
Household: (2 adults, 1 address) $30.00 or $31.20 if using PayPal.
Senior: (1 adult 65 or over) $10.00 or $10.61 if using PayPal.
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| Individual | |
| Junior | |
| Household | |
| Senior | |
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| Please choose your payment method below! |
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| Pay with Check | |
| Pay using PayPal | |
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By paying my dues, I indicate that I have read the Constitution and Bylaws, and the Code of Ethics of the United Poodle Breeds Association and agree to abide by them, and to do my part to support the goals of the UPBA in preserving, protecting and promoting versatile Poodles and Standard Poodles. I am in good standing with the United Kennel Club.
The Association year begins on January 1. Dues are good through December 31. A new member who has joined the Association during the months of October, November, or December shall be considered automatically paid up for the next year. Dues are nonrefundable and are not pro-rated.
Make check payable to: United Poodle Breeds Association and mail to:
UPBA Treasurer, Ann Addison,
5 Helena Circle,
Columbia, SC 29209
If using PayPal, Recipient's Email is: upba@earthlink.net
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