Application for Membership

Name

Address

City State Zip

Home Phone ( ) Work ( )

Email

Kennel Name

Your Occupation

Are you over 18 years of age?

Are you or your immediate family the owner of a Poodle at this time?

How many Poodles do you own?

What size do you have or is of interest to you? (Check all that apply) T M S

Are your Poodles registered with the AKC?

Are your Poodles individually identified? (Tattoo, Microchip, etc.)

Have you ever: Exhibited Bred Judged Poodles?

Have your privileges ever been suspended or revoked by the AKC or any Club? IF YES, Please explain:

Are you a member of any other dog or breed clubs? IF YES, Please list:

Is your business or an immediate family member connected with dogs or dog equipment? IF YES, Please

explain:

Are you willing to serve on a committee of the PCCI?

Are you willing to work as a member of this club for the advancement of the Poodle Fancy, Good Sportsmanship, and in the Best Interest of the Club?

Please indicate areas of interest: (Check all that apply) Conformation Obedience Rally Agility

Breeding Rescue Other

Please remark on any further information that you want to present to the club with your application:

I, THE UNDERSIGNED, herby apply for membership to the Poodle Club of Central Indiana, Inc. (PCCI). I agree to abide to the Constitution, By-Laws, and Rules & Regulations of the Club and of the AKC. I have fully read and truthfully answered all of the questions. I also understand that the placement or sale of any puppy/dog to a broker or pet shop is cause for immediate dismissal from the Club Membership.

Signature of Applicant Date / /

SPONSOR MEMBERS:

1.

Signature Date / /

2.

Signature Date / /

A $15.00 Fee is due at the time the application is submitted. Please make checks out to PCCI.

If you are accepted into the club in the months of October or November, there is no fee due for the following year.

Annual dues are due by the end of January of each year.