***Membership Application***
Date_______________
Name______________________________
Phone _____________________Address__________________________
City____________ State_____________
Email _____________________
Circle
One: Single Rate: $15.00 Family
Rate: $25.00
(Family
Rate/Household Rate is for any 2 adults in the same household)
List Family Members:_____________________________________________________________________________
Circle At Least One:
Are your interests mainly:
Conformation Weight Pull Obedience Agility Herding
Other:___________
Circle At Least One:
I want to help with: Raffle
& Fund Raising Committee Show
Committee Newsletter Committee
Photo & Public Relations Committee
Advertisement Committee
Other:_____________
How many U.K.C. dogs do you
own? _______________________
Are you affiliated or associated
with any other dog registry? Yes No
If so, which registries? _____________________________________________________________________________
Sponsoring Member:_______________________________________________________________________________
I have read the club constitution
and by-laws and agree to abide by and support the rules and purpose of the club
and those of United Kennel Club, Inc. I understand that any misrepresentation of these
facts or any violation of these rules forfeits membership with no refund.
Signed __________________________Date________________________
Signed __________________________Date________________________
