Southern Classic Canaan Dog Club
Membership Application
Name:________________________________________________________________________________
Address:______________________________________________________________________________
Phone: ________________ (home)
___________________ (work)
Fax: _______________________
Email:
__________________________________
Occupation: _________________________________
For Family Membership, please complete the following for second adult member:
Name:________________________________________________________________________________
Address:______________________________________________________________________________
Phone: ________________ (home)
___________________ (work)
Fax: _______________________
Email:
__________________________________
Occupation: _________________________________
For Family Membership, please complete the following for additional household
members,
if Junior member is included in Family membership, please include age of Junior
Member:
Name: _______________________________________ Email:
_________________________________
Type of Membership: Regular _______ Associate* _______ Junior _________ Age
_______
Individual _____ $10.00 Family _____ $15.00 Junior** _____ $2.00
*residing outside of SCCDC geographical area
**for Junior Members wishing to join that are NOT included in a Family
Membership
Please select if you are: (choose one or more)__ Breeder (B*), __ Exhibitor
(E**), __ Dog Owner (DO***),
__ AKC Judge (J****), __ Fancier (F*****)
*B - if you have registered one or more litters within the
past three (3) years
**E - if you have entered an AKC licensed event within the past two (2) years
***DO - if you are not actively breeding or exhibiting
****J - AKC licensed judge, please include breeds/events (i.e. JS, Obed, etc.)
licensed in comment section.
*****F - Currently without a dog, but interested in the breed
Active in dogs since (date)
________________________________________________________________
Please list AKC licensed clubs of which you are presently a
member:_________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list other canine related clubs (non-AKC licensed) of
which you are a member (i.e., Humane Society, Rescue, etc):
______________________________________________________________________________________
______________________________________________________________________________________
Please indicate your interest(s): ___ Conformation, ___ Obedience, ___ Agility,
___ Tracking, ___ Herding,
___ Canine Good Citizen, ___ Companion, ___ Other - please xplain__________________________________
If you have placed a title on a dog(s) that you own, within the past two (2)
years, please list dog's name,
breed and title achieved below (need not be an AKC title):
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Please list AKC registered name(s) and AKC number(s) of dog(s) owned, please
also include breed:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Average number of litters per year:
___________________________________________________________
Please indicate area(s) of interest in the SCCDC:
___ Club Officer, ___ Match Volunteer, ___ Show Volunteer, ___ Public Education,
___ Fund Raising,
___ Newsletter Contributor, ___ Committee Member, ___ Advertising, ___ Club
Socials, ___ Event Coordinator,
___ Other ______________(please indicate)
Please give a brief statement of why you would like to
join the Southern Classic Canaan Dog Club:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Additional Comments (please attach an additional piece of paper, if necessary):
______________________________________________________________________________________
______________________________________________________________________________________
Have you ever been the subject of disciplinary proceedings by any club or
organization whose interests are canine
related?________ If yes, please explain when and under what circumstances:
______________________
______________________________________________________________________________________
I agree to abide by the Constitution and By-Laws of the Southern Classic
Canaan Dog Club and the rules of the
American Kennel Club.
Signature: _________________________________________ Date:
_________________________
Signature: _________________________________________ Date:
_________________________
SCCDC Regular Members endorsing this applicant:
SCCDC Regular Member
__________________________________________________________________
SCCDC Regular Member
__________________________________________________________________
02/27/2000 1:58 PM
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