Palouse Hills Dog Fanciers, Inc

Palouse Hills Dog Fanciers, Inc.

Membership Application

Name / Occupation
Spouse Name / Spouse Occupation
Address / Phone
Email
Web Site / Today’s Date

Breed(s) Owned/Interest in______

______

Please Check Interests:

□Conformation / □Agility / □Tracking / □Field Trials (Lure Coursing, Earthdog, Hunting, etc.)
□Obedience / □Herding / □Judging / □Other

Individual, family, and junior/associate memberships are available. Dues must accompany application.

□Individual
□Household/Dual
□Junior or Associate / $20 per year (November to November – dues are not prorated)
$25 per year (November to November – dues are not prorated)
$5 per year (November to November – dues are not prorated)
Junior or Associate members are not allowed to vote or hold office but may take part in other club functions and receive the newsletter.
I/We______, hereby make application for membership in the Palouse Hills Dog Fanciers, Inc. If elected to membership, I/We hereby agree to abide by the Constitution and By-Laws of the Palouse Hills Dog Fanciers, Inc., and the Rules and Regulations of the American Kennel Club.
Applicant’s Signature
______
All membership applications are reviewed for acceptance by the current membership. Applicants must attend two regular meetings prior to membership application review. Applicants are also required to have sponsorship by a member in good standing. At the request of an applicant, a sponsor will be assigned.
Sponsor’s Name
______
Sponsor’s Signature
______

See second page for Questionnaire

Questionnaire

Have you previously been a member of a dog organization? ___Yes ___No

If yes, which dog organizations have you belonged?

Have you ever served in office or on a committee in these clubs? ___Yes ___No

If yes, on which offices and/or committees have you served?

What breed(s) of dog(s) do you own?

How many dogs do you own?

How many litters have you bred in the last five years?

Have you trained an obedience dog? ___Yes ___No

If yes, have you or do you plan to enter in obedience trials? ___Yes ___No

Have you shown dogs in breed competition? ___Yes ___No

Have you trained an agility dog? ___Yes ___No

If yes, have you or do you plan to enter in agility trials? ___Yes ___No

How many of the following titled dogs have you finished/owned?

□CH / □CD / □CDX / □UD / □OTCH / □TD / □TDX
□NA / □OA / □AX / □MX / □NAJ / □OAJ / □AJX
□MXJ / □NAP / □OAP / □AXP / □MXP / □NJP / □OJP
□AJP / □MJP / □MACH / □CGC / □OTHER
Please give a short statement of your dog showing background or dog related interests: / For Board use only:
Date of Attendance:
1st______
2nd:______
Approved______
Disapproved______
Reason for disapproval:
Palouse Hills Dog Fanciers, Inc.
c/o Marie Taylor
131953 SR 26
Colfax, Wa99111