BMDCW New Membership Application Form

BMDCW Membership Application

To apply for membership please complete all questions.
Name

First NameLast Name
Additional Household Member Name
Address

Kennel Name (if applicable)

Street Address

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
E-mail
example@example.com
Occupation(s)
Home Number
Format: (000) 000-0000.
Cellular Number
Format: (000) 000-0000.
Are you interested in participating in the BMDCW Group E-mail list?
Would like to receive the newsletter?
# of BMD's Owned
# of other Dogs
BMD #1
BMD #2
List more BMD's here, if applicable:
Please check off all interests:
Please consider helping with club activities - remember this is your club. Are you willing to help with club activities?
1. If you clicked Yes above, how can you contribute to this club?
2. Do you have an active membership in any other dog clubs? If "yes", please list club(s)?
3. What interests do you have aside from your involvement with dogs?
4. Have you attended any club activities? If "yes", please list event and date?
5. What benefits do you hope to derive as a member of this club?
If you have any other comments, please provide them below.
Note: Each family member applying for membership must sign this application after reading the Code of Ethics.
I agree to abide by the rules and regulation of the AKC and the Constitution and Bylaws of the BMDCW , which contribute to the betterment of the Bernese Mountain Dog.

BMDCW Code of Ethics
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Membership Options
prevnext( X )
Regular Membership — first adult member in household (Voting; requires 2 Club sponsors)
$25.00



Regular Membership — each additional member in the same household
$10.00



Senior Membership — first regular senior member (over age 60)
$20.00



Senior Membership — each additional senior member in the same household
$5.00



Junior Membership (ages 9 to under 18; no voting, office-holding, sponsoring, nominating, or seconding privileges)
Free



1 year Free Membership for Rescue or BMDCW Breeder puppy purchase
Free



Mailed copy of newsletter to the address above
$10.00



Additional contribution to Club funds (for example: Rescue Fund, Trophy Funds, or General Club Fund)
Custom amount

Free



Total enclosed
Free



Total

$0.00
Enter date and breeder or rescue contact name here:
Date Purchase or Rescued

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
This application may take several weeks to process. Depending on how late in the year your application is made, your dues may be applied to the next calendar year.

If you have any questions please reach out to Heidi Henderson, BMDCW Membership Chair

Cell: (201) 310-9346

Email: snowpawbmd@gmail.com

If you would like to mail your Membership fee please send your check to:

Heidi Henderson: 376 Coffeehouse Rd., Killington, VT 05751

If you'd like to pay via Paypal please click the link on the next page after you Apply for Membership below.

Thank you Very Much!!
Should be Empty:

BMDCW Membership Application

Membership Options*

Membership Options