| 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| Explain if any AKC privileges have been revoked or suspended | |||||||||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: | ||||||||