HOOSIER BASENJI CLUBIndianapolis, Indiana
The Hoosier Basenji club is a non-profit breed club developed to educate the Basenji enthusiast and to strengthen and promote the Basenji breed.
This application will be submitted to the general membership for their approval. Yearly dues are: $10.00 Single, Junior $15.00 Family.
NAME_______________________________________________________________
ADDRESS____________________________________________________________
CITY__________ZIP_______________PHONE______________________________
OCCUPATION___________________________________No. OF DOGS______
__M__F Reg. Name_______________________Call Name______________
__M__F Reg. Name_______________________Call Name______________
__M__F Reg. Name_______________________Call Name______________
__M__F Reg. Name_______________________Call Name______________
List additional dogs on back.
How many litters have you had in the past 5 years?________________
Do you currently have: __Show Dogs __Stud Service __Puppies __Obedience Dogs __Lure Coursing __Pets
Are you interested in: __Show __Obedience __Breeding __Lure Coursing __Pet
Previous dog experience. (Basenji or other breeds)
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Any other dog organizations you belong to?_______________________________________________
Are you interested in committee work? __Y__N __Membership __Hospitality __Show __Fund Raisers
Any other special talents you are willing to share?_____________________________________________________________________
_____________________________________________________________________
Signature of sponsor members
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APPLICANTS SIGNATURE_________________ Date________________________
APPROVED BY MEMBERSHIP__________________________________________
1st. Reading Date_______________
2nd. Reading Date_______________
HBCAPPL.PEG 4/91
Please mail to: Fritz Fralick, 3627 Oakwood Dr., Anderson, IN., 46011
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