PAC Member Form

First upload your organizations logo to be displayed on the site. Formats accepted are .jpg, .jpeg, .gif and .png. The File size upload limit is 1mb.

Business Information

Business Type:
Pet Friendly?
Business Name:
Address:
City, State and Zip
Mailing AddressAddress:
City, State and Zip
Short Description - This will appear in your RCHS Website Listing.

Contact Info

Primary Contact:
Alternate Contact:
Phone:
Public Phone:
Email:
Website:
Referred By:
Membership Level: Hound $75 Retriever $125 Sheperd $250

Payment Information

First Name
Last Name
Phone:
Email
Address
Address 2
Address 3
City
State
Zip Code
Name on Card
Credit Card Number
CCV
Expiration