Membership Application

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First name*

Last name*

Email*

Phone*

Address*

Occupation*

Hobbies*

Registered name of dogs*

Number of dogs*

Breed or Variety*

Dog(s) age*

Dog(s) call name*

Color(s)*

Variety*

Toy

Miniature

Standard

Tell us where and how much training, either show, obedience or field, your dog has received*

Have you or your family ever been sanctioned or expelled by the AKC?*

Yes

No

If yes, please explain

Do you agree to abide by the Constitution, By-Laws, and Code of Ethics and the rules of the AKC?*

Yes

No

Type of Membership*

Associate (required for the first year)

Regular

Junior

Sponsor*

Signature*

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