New Membership Application

Applicant 1 name

First NameLast Name

Applicant 1 occupation

Applicant 1 Email

example@example.com

Applicant 1 Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Applicant 2 name if applying for Household membership

First NameLast Name

Applicant 2 occupation

Applicant 2 Email

example@example.com

Applicant 2 Cell Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Additional phone number

Please enter a valid phone number.Format: (000) 000-0000.

How would you like to receive PONC's newsletter, "The Hot Spot"?

Are you a member of the Newfoundland Club of America?

Please list other dog clubs or regional Newfoundland clubs to which you have belonged and indicate whether you are a current member

If you ever had membership or showing privileges suspended, please explain.

PONC depends upon the active participation of its members to thrive. Please indicate activities about which you would like to learn or with which you could help.

How many years have you owned Newfoundlands?

Please enter the names and birthdates of the Newfoundlands you currently own.

Do you breed dogs?

Kennel name; How many brood bitches and stud dogs?

New membership applicants must be sponsored by a current PONC member. A great way to meet current members is to attend PONC events. They are listed on our website (www.ponc.org) and our Facebook page (Penn-Ohio Newfoundland Club). Please fill in the name of your sponsor. If you do not have a sponsor, please contact Brian Mikelbank at "brian.mikelbank@gmail.com"

Name of Sponsor

I/we agree to abide by the Constitution, By-Laws, Ethics Guide and Safety Policy of the Penn-Ohio Newfoundland Club, Inc.

Signature

Application Fee

If approved for membership, your application fee will count as your first year's dues. If you apply after November 1st, your dues will apply to the next membership year.

Check the appropriate box below, then click SUBMIT. You will be taken to a secure payment site to enter your credit card information.

If you wish to pay your membership dues by mail, do not check any payment boxes. Just click on SUBMIT and send your check made payable to PONC to the Treasurer:

DAVID HARTMANN
260 OLD MILL RD
PITTSBURGH, PA 15238-1938

For questions, E-mail membership@ponc.org or call (216 797 9905) Brian and Kristen Mikelbank, Membership Co-Chairs.

Individual Membership

$20.00

Household Membership

$30.00

Junior Membership

$10.00

Total

PONC New Membership Application