West Highland White Terrier Club of Indiana
Membership Application
Name           Phone    
Address         City, State, Zip    
E-Mail Address              
Employer     Occupation      
Other Dog Club Affiliations            
Breed of Dog(s) you now own            
Number of dogs of each breed you now own        
How many litters have you bred in the last 3 years?      
Are you a member in good standing with the AKC?   Yes   No
Explain if any AKC privileges have been revoked or suspended    
Other hobbies              
In what capacities are you willing to work for the club?      
This application must carry the signature of a current member who is willing to sponsor 
you.  Applicants for regular membership must attend a meeting of the club before this 
application can be acted upon.
Check type of membership: Regular   Associate (Non-voting)  
Applicant's Signature            
Sponsor's Comments            
Sponsor's Signature            
For Club Use Only:
Date received:   Read At Meeting:  
Date Accepted:   Dues Paid: