Great Lakes Working Group Dog Association Application Form

Great Lakes Working Group Dog Association

Membership Application and Questionnaire
Full Name *

First Name Last Name
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Membership Type: *

Regular ($25 or $12.50 if after July 1st) Junior ($5) Voluntary Monetary Contribution Apply to the General Fund 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)

Conformation Obedience Rally Rescue Therapy dog Nose work Agility Barn Hunt Coursing Activities Performance Judge
If Performance (please list) please list
Have you ever been denied membership to a dog related club?

Yes No
If yes, please explain:
Have you ever been suspended by the AKC?

Yes No
If yes, please explain:
Are you or is anyone in your household involved in any dog or animal related business?

Yes No
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

Month Day Year
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:

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