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West Mississippi Hunting Retriever Club Membership Form


WMHRC
Tom Weeks - Secretary
128 Westwood Dr
Vicksburg MS 39183


Please fill out the below information and return to the address listed above along with a check for $35 made out to West MS HRC. The annual dues are $35.

Name: ____________________________________________________________

Address: ___________________________________________________________

City/State/Zip: ______________________________________________________

Email: _____________________________________________________________

Ph. No.: ____________________________________________________________

Dog Name with Titles: ________________________________________________

Dogs Call Name: _____________________________________________________

HRCH membership #: _________________________________________________

List Additional Dogs Below: