Cactus State

Bouvier des Flandres Club

Membership Application

 

 

 

TYPE OF MEMBERSHIP: Please Mark One.

 

Voting Memberships:                                                Non-Voting Memberships:

 

” Individual - $25.00                                                     ” Junior - $15.00

(Individual memberships are entitled to participate in club                      (Under 18, who owns or co-owns a Bouvier des Flandres,

activities and receive newsletters, vote and hold office.)                        entitled to participate in club activities and receive

                                                                                                         newsletters, but cannot hold office.)

 

 ” Family - $35.00 (2 votes)                                                     ” Associate - $25.00

(Family memberships are entitled to participate in club                          (Doesn’t need to own a BdF, entitled to participate in

activities and receive newsletters, vote and hold office.)                        activities and receive newsletters, but cannot hold office.)

 

 

               Name:_________________________________  Phone:___________________________

           

            Name:_________________________________   Fax:____________________________

 

            Address:_______________________________    E-Mail:_____________________

 

            Address:_______________________________

 

Kennel Name:_________________________________

 

If accepted into membership, I (we) hereby agree to abide by the Constitution, By-Laws, Code of Ethics, and Rules and Regulations as set forth by the American Kennel Club and the Cactus State Bouvier des Flandres Club.______ (Initial)

 

_______________________________________                              ______________________

Signature of Applicant                                                                        Date

 

________________________________________                            _______________________

Signature of Applicant                                                                        Date

 

________________________________________                ______________________________

Sponsor’s Signature                                                                            Print Sponsor’s Name

 

________________________________________                ______________________________

Sponsor’s Signature                                                                            Print Sponsor’s Name

 

Make check payable to CSBdFC.  Mail completed application and check to:

          Barbara L. Luke, 1708 E. Pinchot Ave., Phoenix, Az. 85016

For Club Use

Check Number:____________                 Date application received:______________

Application accepted:____________       Date application submitted to the board:____________

Application denied:____________          Date published to General Membership:____________

Cactus State

Bouvier des Flandres Club

Membership Application

Page 2 - Information

 

Applicant’s Name(s):______________________________________________________________________

 

Areas of interest for dog activities: Please mark all that interest you.

 

Conformation ”              Obedience ”                    Breeding ”            Herding ”

 

Tracking ”                      Agility ”                Carting ”               Weight Pull ”

 

Therapy Work ”                        Other Specify ” ___________________________

                             

Other dog clubs/organizations to which I (we) belong:____________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

Names and ages of dogs owned:____________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

 

Breeding activity, (Litters in the last three years): ________________________________

________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

 

Exhibiting activity, (List some activities you have been involved in the last three years):

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

List any A.K.C. titles earned and the names of the dogs who acquired them: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Why do you want to be a member of this club?:___________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________