Chintimini Kennel Club Member Application Form

Chintimini Kennel Club Member Application Form

Applicants must attend at least 1 club monthly meeting OR volunteer at a CKC sponsored event prior to submitting application. Membership vote is held after the reading of the application at the next club meeting.
Applicant: *

First Name Last Name
co-Applicant:

First Name Last Name
Kennel Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email

Confirmation Email example@example.com
Applicant Phone Number *
Please enter a valid phone number.
co-Applicant Phone
Please enter a valid phone number.
Applicant Occupation *
co-Applicant Occupation
Membership Type:

Individual/Household (voting) Associate (non voting) Junior (non-voting - please enter age below)
Age of Junior if applicable
Number of Years in Purebred Dogs *
Number of litters registered in the past 3 years *
Please list dog breed(s) you have owned (past and present; enter "none" if appropriate): *
Please list other dog club affiliations and offices held with each club (enter "none" if appropriate): *
I (we) am (are) interested in: *

Conformation Obedience Rally Agility Pet Breeding Field Event Lure Coursing
Other Interests in addition to above?
Why do you want to join the CKC? *
Have you volunteered at a CKC sponsored Event *

Yes No
If you volunteered at an event please list the event and date and name the CKC and list the CKC member who can sign your application
Have you ever been suspended by the AKC or any other dog club? *

Yes No
Have you ever been cited by the SPCA, any humane society or animal control organization? *

Yes No
Have you at any time been associated with, or sold dogs to a wholesale or retail canine operation? *

Yes No
Please explain any Yes answers to any of the above three question
I (we) have asnwered these statements honetly and I (we) certify that I (we) am (are) in good standing with the American Kennel Club. I (we) agree to abide by the rules and regulations of the American Kennel Club as well as the Constitutions and Bylaws of the Chintimini Kennel Club (CKC).
I Accept this Agreement *

Please Select to indicate your acceptance
Name of CKC member who will endorse this application *
Name of second CKC member who will endorse this application *
Do you agree to having meeting notices and other club notices sent by email rather than through the post office

Yes No
Annual full memberships fees are presently $10/single or $15/househould (2 adults).

Annual fees for Associate and Junior members are $5 per person.

Fees can be paid via credit card below. Fees will be refunded if for some reason your application is not accepted.

My Products

Member Ship Fees

$ 15.00 Membership Class

Total

$ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty: