Pomeranian Club Of Central Indiana, Inc
Application for Membership
(Please Print Clearly)
Notice: Applications must be endorsed by TWO members in good standing (a) who have been PCCI members for one (1) year or more; (b) who have known the applicant six (6) months or more; (c) who do not reside in the same household; (d) who are not related to each other or the applicant.
Applications must be accompanied by the correct dues amount. Answer all questions.
This membership application is for: REGULAR_____(Single)(Joint)______ASSOCIATE_____JUNIOR_______
Name:________________________________________________________________________________________
Occupation:____________________________________________ Telephone No_(_____)__________________
Spouse Name:_______________________________________________Occupation_______________________
Complete Address:____________________________________________________________________________
City___________________________________________State______________Zip_________________________
Work Telephone No_____________________Email Address:________________________________________
Do you participate in Rescue?__________ Were you previously a member of PCCI?_______When?_______
Are you currently a Breeder______Exhibitor_______Obedience_______Owner_______Other_____________
How many Pomeranians do you own/co-own?____________Do you own/co-own other breeds___________
Is so, which breeds?_________________Have your privileges from the American Kennel Club ever
been suspended?____________If so, Please give details__________________________________________
How many litters have you bred in the last five (5) years?_________________
Do you belong to any other breed/kennel clubs?___________List memberships in any all-breed, specialty
Or obedience clubs in which you now or have been a member. Give Dates.___________________________
_______________________________________________________________________________________________
Have you ever held office in the above club’s?_______What office or committees have you held__________________________________________________________________________________________
PLEASE NOTE: Money accompanying this application is a deposit of good intent and will be applied to membership dues upon your acceptance into the Pomeranian Club Of Central Indiana, Inc. If your membership is rejected, your deposit will be returned.
I, an applicant for membership certify that I have read and understand the Code Of Ethics and agree to abide by them and the Constitution & By-Laws of the Pomeranian Club Of Central Indiana, Inc., if elected into membership.
Applicant/s (Spouse) Signature:___________________________Signature______________________________Date:____________
Type of Memberships:
Regular Membership---- ($15.00 single/$20.00 joint) An individual applying for regular membership must attend two (2) meetings prior to submitting applications. Regular members are expected to attend at least half the meetings and take an active part in the club business and organizing events. Regular membership enjoys all privileges of the club including voting and holding office, and is open to all persons 18 & older. A husband & wife constitute a joint membership (both must reside at same address), with each individual having one vote.
Associate Membership--- ($18.00 per household) Associate members may attend all social functions and meetings and receive the newsletter. They may voice their opinions on club business, but cannot vote or hold office. They may act as committee members (with exception of the Nominating Committee) but not as chairperson. There is no requirement to attend meeting before applying for associate membership and they may re-apply for a change to regular membership at a later date.
Junior Membership--- ($5.00 single) Junior members between the ages of 10 and 17 may enjoy all the privileges of the club, but cannot vote or hold office. They may act as committee members (with the exception of the Nominating Committee) but not act as chairperson. Junior members may automatically convert to regular membership upon their 18th birthday.
Make Checks payable to the Pomeranian Club Of Central Indiana, Inc. and submit with the application. Mail to;
Cathy Gould 197 E 150 N Washington, IN 47501 Email; crgould@avenuebroadband.com
______________________________________________________________________________________________
Sponsor - Reference #1
How long have you known the applicant? ___________Have you met the applicant in person? _________ Have you been in the applicant’s home?__________Why do you recommend the applicant(s) for membership?__________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
I, as a member in good standing, believe that the applicant(s) should be considered for the type of membership requested. (If this application is for regular membership) I know the applicant(s) and have knowledge of how they care for their dogs. I believe that they are of good character.
Print Name________________________Signature(s)___________________________________Date_________
Sponsor - Reference #2
How long have you known the applicant?___________Have you met the applicant in person?_________ Have you been in the applicant’s home?__________Why do you recommend the applicant(s) for membership?________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I, as a member in good standing, believe that the applicant(s) should be considered for the type of membership requested. (If this application is for regular membership) I know the applicant(s) and have knowledge of how they care for their dogs. I believe that they are of good character.
Print Name________________________Signature(s)____________________________________Date_________
Do not write below this line, for official use only.
Date Application received______________ 1st Reading__________________2nd Reading_________________
Date Dues received:_____________Amount:________Check No:__________To Treasurer:________________
Membership Approved__________________Membership Rejected_____________Check sent_____________
(PCCI- revised 010808)