Great Lakes Working Group Dog Association Application Form

Great Lakes Working Group Dog Association

Membership Application and Questionnaire
Full Name

First NameLast Name
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Membership Type:

Other
How many Working Dogs do you own?
Co-own?
Working Dog Breeds:
Other breeds (Please list breeds and numbers of dogs in the household):
Do you participate in any of the following? (check all that apply)
If Performance (please list) please list
Have you ever been denied membership to a dog related club?
If yes, please explain:
Have you ever been suspended by the AKC?
If yes, please explain:
Are you or is anyone in your household involved in any dog or animal related business?
If yes, please explain:
*The GLWGDA does not share its membership list or give its permission for its list to be used by anyone, except for the express purpose of communicating GLWGDA events, GLWGDA information with the membership and per the AKC Event Operations Department’s policy.
Date

MonthDayYear
My signature on this document verifies that the information provided herein is complete and truthful to the best of my knowledge. Any falsehood will be grounds for expulsion.
Your name
E-mail
example@example.com
Should be Empty: