IHCUS Membership Application Form

IHCUS Membership Application

It is important that you read the "Membership Application Instructions" which can be found on the IHCUS website at www.ihcus.org/join/
Membership Type*

Full Individual MembershipForeign Membership
Number of Applicants*

12
Applicant Name*

First NameLast Name
Applicant Occupation*
(if retired what was your Occupation)
Applicant Interests*
Second Applicant Name

First NameLast Name
Second Applicant Occupation
(if retired what was your Occupation)
Second Applicant Interests
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Electronic Notifications
Members are encouraged to elect to receive electronic notifications (i.e. email) regarding Club business. New Members will automatically receive electronic notifications unless the box is checked stating they do NOT want electronic notifications on the Membership Application. Not all correspondence will be done electronically. Election ballots (for example), will continue to be processed in the usual (paper) manner.
Applicant Phone Number*

Area CodePhone Number
Applicant E-mail*
Applicant Electronic Notification Approval

I do NOT want to receive electronic notifications from IHCUS
Second Applicant Phone Number

Area CodePhone Number
Second Applicant E-mail
example@example.com
Second Applicant Electronic Notification Approval

I do NOT want to receive electronic notifications from IHCUS
Kennel Name:
Website:
Sponsors

(a minimum of two (2) sponsors are required - be sure to attach sponsorship forms – Sponsors MUST be an IHCUS Member , in good standing. The Sponsor must have been a member, in good standing, for a minimum of one year – Relationships based solely on “Social Media” does not constitute “knowing” the person. (Encouraged but not required for Foreign Membership applicants)
Sponsor #1    First Name*   Last Name*
Sponsor #2   First Name*   Last Name*
Sponsor #3   First Name   Last Name
Sponsorship Form Format*

AttachedFilled out using Sponsorship Jotform
Attach Sponsorship forms here

Cancelof
Why do you wish to join IHCUS?*
Have you ever been suspended from AKC privileges or any dog club?*

NOYESIf YES - Explanation:
OWNERSHIP - List all of the dogs you previously & currently own or co-own *
Rescue Fostering
Would you be able to foster a Rescue Ibizan?*

YES (Temporarily)YES (Permanently)NOForeign Member - N/A
LITTERS – List the litters you have bred*
List the stud services your dog(s) has/have provided: *
N/A if not Applicable
What health tests do you currently do on your adult dogs and puppies? *
Are you willing to screen your dog(s) for hereditary genetic problems before breeding?*

YESNON/A
Do you agree to allow an inspection of your kennel facilities if requested by the IHCUS Board?*

YESNON/A
Do you accept responsibility for any dog of your breeding which comes into a rescue situation?*

YESNO
Do you or have you ever sold or consign dogs to retail or wholesale outlets or other persons supplying them?*

YESNO
ACTIVITIES – Which of the following activities interest you?*

ConformationObedienceAgilityCoursingTrackingOther
PARTICIPATION – List the clubs and dog related organizations (breed, performance) to which you belong*
Additional Comments
DISCLAIMER AND SIGNATURE (My signature below is an acknowledgement of and agreement to the following)

I certify that my answers are true and complete to the best of my knowledge.If this application leads to membership, I understand that false or misleading information in my application may result in expulsion.I give IHCUS my permission to contact the references listed in this application.I give IHCUS members my permission to review this application.I have read the IHCUS Constitution and By-Laws, the Club’s Code of Ethics and agree to abide by them.I am aware of the rules of the American Kennel Club and agree to abide by them.I consent to IHCUS sharing my membership information, as necessary,with the American Kennel Club (AKC) and other third parties for purposesrelated to club business.I agree to participate in and be bound by decisions madethrough electronic voting methods as adopted by IHCUS.
Signature

Clear
Date

MonthDayYear
Date
Payment Method*

CheckPayPal
Total Application Fee: Check
Includes $25 Application Fee
Total Application Fee: PayPal Calculation
Includes $25 Application Fee
See Total Application Fee: Check Field for amount due.

After form submission, Make check for application fee (payable in US Funds) to IHCUS and Mail to:

Pam Fusco (IHCUS Treasurer)
3451 S Grosvenor Hwy
Palmyra MI 49268

Membership Application will not be process until after payment receipt.
Total Application Fee: PayPal

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USDMembership Application, Includes $2 Convenience Fee
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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IHCUS Membership Application

Electronic Notifications

Sponsors

Rescue Fostering