Update Affiliate Club Info

Use this form to update your affiliate club information on file with the PCA.
Only fill in what needs to be updated or corrected.

Note: Listing contact information on the website is optional. By default we list the President, Secretary, Breeder Referral & Rescue Contacts.

Fields marked with * are required.

"*" indicates required fields

X/Twitter

This field is for validation purposes and should be left unchanged.

State*

Affiliate Club*

Club Website

President Name

First Last

President Email

President Phone

President Address

Street Address City State ZIP Code

Corresponding Secretary Name

First Last

Corresponding Secretary Email

Corresponding Secretary Phone

Corresponding Secretary Address

Street Address City State ZIP Code

Recording Secretary Name

First Last

Recording Secretary Email

Recording Secretary Phone

Breeder Referral Name

First Last

Breeder Referral Email

Breeder Referral Phone

Poodle Rescue Name

First Last

Poodle Rescue Email

Poodle Rescue Phone

Your email*

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