Interested in Becoming a Chintimini Kennel Club Member?

Chintimini Kennel Club

Membership Application Form
To be eligiable to become a member, candidates must attend at least 1 club meeting or volunteer at a CKC sponsored event prior to submitting their application. A paper copy of the Application Form with signatures by club members sponsoring you application must be submitted to the Club Secretary before a membership vote can be taken. Membership vote is held after the reading of the application at the next club meeting.

Payment of Membership Fee is required
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*

Confirmation Emailexample@example.com
Applicant Phone Number*
Please enter a valid phone number.
Type of Membership:*

Individual (voting $10)Household (2 adults, voting $15)Associate/Junior (non-voting $5)
Number of Years in Purebred Dogs*
Number of Litters in last 3 years*
Please list dog breed(s) you have owned (past and present; enter "none" if appropriate):*
Please list other dog club affiliations and any offices held with each club*
I (we) am (are) interested in:*

ConformationObedienceRallyAgilityPetBreedingField EventLure Coursing
Other Interests in addition to above?*
Why do you want join Chintimini Kennel Club?*
List member's of Chintimini Club that can sponsor you membership*
Have you volunteered at a Chintimini Kennel Club AKC Sponsored Event?*

YesNo
Date of the Event

MonthDayYear
Date
Name of Event
List Any Other Events
Have you ever been suspended by the AKC or any other dog club?*

YesNo
Have you ever been cited by the SPCA, any humane society or animal control organization?*

YesNo
Have you at any time been associated with, or sold dogs to, a wholesale or retail canine operation?*

YesNo
Please Explain any Yes answers to the above three questions.*
I agree to have meeting notices and other club notices sent by email rather than through the post office,*

YesNo
I (we) have answered these statements honestly 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 Constitution and Bylaws of the Chintimini Kennel Club (CKC).
Check this box to indicate that this statement is true*

This Statement is True
Membership Fee

Fee Payment*

USDDescription

Credit Card

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