__MEMBERSHIP APPLICATION

MEETINGS ATTENDED

DATE

DATE ACCEPTED

MEMBERSHIP APPLICATION

Annual Dues: Individuals - $12.50 Joint - $15.00 Juniors - $1.00

Renewal Date: January 1

Membership 18 yrs. and over Junior Membership - Ages 12 – 17

Please print this application, complete it, and bring it to a monthly PCKC meeting.

Thank you for your interest in the Plum Creek Kennel Club!

Name(s)

Address

Home Phone

Work Phone

Kennel Name

Have you ever been suspended or otherwise disciplined by the American Kennel Club? YES NO (circle one)

If you indicated YES, please provide us with full details on a separate sheet and attach to this application.

List other dog club memberships and offices held

Name of Dog Club	Offices Held

I/we hereby apply for membership in the Plum Creek Kennel Club of Colorado. If accepted, I/we agree to abide by the Constitution and By-Laws of the Plum Creek Kennel Club of Colorado and the rules of the American Kennel Club.

Signed:__________________________________________________________________________Date:__________________________

Names of PCKC Sponsors

Name:

Address:

Signature:

Name:

Address:

Signature:

Please list any committees you would be interested in serving on: _________________________________________________________________________

___________________________________________________________________________________________________________________________

Please include the following information:

Breeder Since:

Exhibitor Since:

Pet Owner Since:

Number of Registered dogs owned or co-owned: _______

Name	AKC Registration Number	Breed

Number of Litters bred in the past three years: __________

Number in Litter	Breed	Date of Litter

Number of Dogs you have Titled in the last three years: _________

Name	AKC Number	Breed	Title	Date Titled

I/we Attended an average of _______ shows/year in the past three years, including both local and out of area shows.

Club Name	Date of Show	Club Name	Date of Show