Application for Membership to PNWBCC
Please PRINT and fill out and send to Membership chairperson listed below
PNWBCC MEMBERSHIP CHAIRPERSON
Karen Marquardt
12 Seasons
Drive, DeSmet, ID 83824
_______________________________________________________________________________
Type of Application: Individual ($10) ____ Household ($15) _____ Date: _________
Applicant(s) name: _________________________________________________________________
Other Applicants (if household): _______________________________________________________
Street Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Phone: ___________________________ Email: _________________________________________
Url: ____________________________________ Kennel name?:__________________________
Applicant Profile--We appreciate knowing a little about
your involment in dogs. Thank you.
Current Breeds Owned: _____________________________________________________________
Number of years in dogs? ______________________ In Border Collies? ______________________
Primary areas of interest with the Border Collies? _________________________________________
Are you a breeder? _____________________Years breeding? _ _____________________________
Have you competed in any AKC events in the last year? _______ Which ones? _________________
_________________________________________________________________________________
Area of club related activity in which you would like to be involved? ___________________________
_________________________________________________________________________________
Are you an approved judge/tester for any area of canine activity? _____________________________
If so, which area? __________________________________________________________________
Do you have any special skills that would benefit the club? __________________________________
Please list skills: ___________________________________________________________________
Please list any other dog related clubs you are a member of: __ _______________________________
__________________________________________________________________________________
All applicants must have a sponsor who is a
current member OR be able to attend at least three (3)
meetings within the year of application. You may also attend events/shows
sponsored by the club or not and make an effort to meet members so we can get to
know your needs/ambitions. Thank you for your interest.
Sponsor:___________________________________________________________________________
Signature:__________________________________________________________________________
-------------------Club Use Only--PNWBCC----------------------------------------------------------------------------------
Application Received: __________ Approved By: ____ _____________________________________
Payment Rec'd: ____________ Check Number: ______________ Amount: $ ________________
Renew Dates: ( ) ( ) ( ) ( ) ( ) ( ) ( )
RESIGNED DATE:
PNWBCC MEMBERSHIP CHAIRPERSON
Karen Marquardt
12 Seasons
Drive, DeSmet, ID 83824
_______________________________________________________________________________
Type of Application: Individual ($10) ____ Household ($15) _____ Date: _________
Applicant(s) name: _________________________________________________________________
Other Applicants (if household): _______________________________________________________
Street Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Phone: ___________________________ Email: _________________________________________
Url: ____________________________________ Kennel name?:__________________________
Applicant Profile--We appreciate knowing a little about
your involment in dogs. Thank you.
Current Breeds Owned: _____________________________________________________________
Number of years in dogs? ______________________ In Border Collies? ______________________
Primary areas of interest with the Border Collies? _________________________________________
Are you a breeder? _____________________Years breeding? _ _____________________________
Have you competed in any AKC events in the last year? _______ Which ones? _________________
_________________________________________________________________________________
Area of club related activity in which you would like to be involved? ___________________________
_________________________________________________________________________________
Are you an approved judge/tester for any area of canine activity? _____________________________
If so, which area? __________________________________________________________________
Do you have any special skills that would benefit the club? __________________________________
Please list skills: ___________________________________________________________________
Please list any other dog related clubs you are a member of: __ _______________________________
__________________________________________________________________________________
All applicants must have a sponsor who is a
current member OR be able to attend at least three (3)
meetings within the year of application. You may also attend events/shows
sponsored by the club or not and make an effort to meet members so we can get to
know your needs/ambitions. Thank you for your interest.
Sponsor:___________________________________________________________________________
Signature:__________________________________________________________________________
-------------------Club Use Only--PNWBCC----------------------------------------------------------------------------------
Application Received: __________ Approved By: ____ _____________________________________
Payment Rec'd: ____________ Check Number: ______________ Amount: $ ________________
Renew Dates: ( ) ( ) ( ) ( ) ( ) ( ) ( )
RESIGNED DATE:
