UIRC 2021 Membership Renewal

Upper Island Retriever Club

2021 Membership Application
Residence of member *

In-Town (Qualicum to Sayward) Out of Town
New or Renewal *

New Application Renewal
Type of Membership *

Individual $10 Family $20
Name (Individual Membership) *

First Name Last Name
Primary E-mail address *
Names of Other Family Members

First Name Last Name
E-mail address
Names of Other Family Members

First Name Last Name
E-mail address
Names of Other Family Members

First Name Last Name
E-mail Address
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
How did you hear about UIRC
Number of dogs training in field work

One Two Three Four
Dog #1 Name & Age
Dog #1 Breed
Training Level of Dog #1

Puppy Novice Junior Hunt Test Senior Hunt Test Master Hunt Test Field Trial
Training Goals for Dog #1

JH/WC WCI SH/WCX MH Qual FT Open FT Hunting
Dog #2 Name & Age
Dog #2 Breed
Training Level of Dog #2

Puppy Novice Junior Hunt Test Senior Hunt Test Master Hunt Test Field Trial
Training Goals for Dog #2

JH/WC WCI SH/WCX MH Qual FT Open FT Hunting
Dog #3 Name & Age
Dog #3 Breed
Training Level of Dog #3

Puppy Novice Junior Hunt Test Senior Hunt Test Master Hunt Test Field Trial
Training Goals for Dog #3

JH/WC WCI SH/WCX MH Qual FT Open FT Hunting
Dog #4 Name & Age
Dog #4 Breed
Training Level of Dog #4

Puppy Novice Junior Hunt Test Senior Hunt Test Master Hunt Test Field Trial
Training Goals for Dog #4

JH/WC WCI SH/WCX MH Qual FT Open FT Hunting
What is your primary goal in training

Hunting Hunt Test and/or Working Certificate Tests Field Trial
Will you be participating in the monthly training days?

Yes No
What type of training days are you interested in? (Please check as many as apply)

Drills Water work Upland Hunting Working Certificate set-up Marking set-up Hunting Scenario Field Trial set-up Hunt Test Set-Up Blinds Handling Skills
Other feedback re: training days?
Are in you interested in becoming a training coordinator for club training days?

Yes No
Are you interested in becoming an assistant training coordinator for club training days?

Yes No
Are you interested in becoming a mentor for new or novice club members?

Yes No
In what ways would you like to participate at UIRC test/trial days?

Marshal Thrower/Gunner Equipment Steward Bird Steward Hunt Test/Working Certificate Committee
Are you interested in:

Becoming a volunteer officer of the club Being on the fund-raising committee Looking after equipment
Thank you for joing the Upper Island Retriever Club. As a club we strive to have our UIRC events be a safe and comfortable experience for all handlers and dogs. Please ensure that your dog is under control at all times.

By typing your name below, you agree:

1. To abide by the Constitution and By-Laws of the Upper Island Retriever Club.

2. That I (we) have never been charged or convicted of cruelty to animals.

3. That I (we) understand that if a dog is seen to be menacing, threatening, or attempting to bite another dog or person, that handler may be asked by a member of the Executive, or the training/test committee to confine the dog and no longer participate in the UIRC event. At the discretion of the Executive, the dog may not be permitted to attend future UIRC events.
Signature (typed) *
Date

Month Day Year
Date
Amount Owing
Method of Payment *

E-Transfer Cheque/Cash by mail/in person
Please send e-transfer to UIRCpayment@gmail.com. Code word: retriever
Please make cheques payable to "Upper Island Retriever Club".

Bring to AGM or Mail to:

Carol Redekopp

UIRC Secretary

1657 Maquinna Ave. Comox, BC

V9M 3K9
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Upper Island Retriever Club