Name(s):___________________________________________________________________

Address:_______________________________________________________________________________

City:_______________________________________  State:_____  Zip:_________________

Phone:Home (_____) ______________________ Day (_____) ______________________

E-mail:__________________________________ URL:____________________________

What breeds of dog do you own?_____________________________________________

How many dogs do you own? _____ How many litters have you bred ?_______________

Are you active in;
rescue? _______ conformation?_____  obedience? _____  agility?_____  other? _____

Are you or have you been an active member of any dog club(s)? _____

If so, please indicate name of club(s) and dates:
_____________________________________________________________________________________

_____________________________________________________________________________________

Name of Club(s)                                Dates of Membership                       Office(s) Held/Activities

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Do you have a registered kennel name? ____  If yes, indicate name: _______________________

Do you sell puppies to wholesalers, by litter lots, or for resale? _____

Do you sell puppies to individual buyers? _____

Please describe any activities or special interests, past experience, or any area in which you would be willing to work, that you feel might help you to make contributions to the efforts of this club.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

If accepted for membership, I agree to abide by the Articles of Incorporation and the By-Laws of this club which create and promote good sportsmanship and interest in pure-bred dogs.  I agree to contribute my knowledge and experience when asked and to respect the purpose and support the activities of this club.

______________________________________________________________________
Signature(s) of Applicant(s) and date.

Sponsors:  (1) ______________________________________ date _____________

                   (2)______________________________________ date __________________

Membership Application Submitted at Meeting on : ________/_______/__________

First Reading: ______/______/_______  Second Reading:_____/_______/_____

Approved:  ______/______/_______ . . . Not Approved:  ______/______/_______

Membership fees dues should accompany this membership application.
If the membership is not approved or is withdrawn, the dues will be refunded.

Note:  The membership application may be submitted after attending one function as a guest.
It will be read at the next function the applicant attends and read a second time and voted on at the third event.  If the application is for two persons in same household, both persons must attend.