Australian Terrier Club of Colorado Membership Application

Australian Terrier Club of Colorado Membership Application
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation
Publish this information in the membership phone book:

YesNo
Are you a newcomer to Australian Terriers?

YesNo
If not, how long have you owned Australian Terriers?
How did you become interested in the Breed?
Was the Australian Terrier(s) purchased for:

PetShowObedienceBreedingOther
In which of these activities are you currently active?
Have you ever been a member of ATCC?

YesNo
If YES, when?
Have you ever applied for ATCC membership before?

YesNo
If YES, when?
Why do you want to join ATCC?
Are you willing to work on Club Committees?

YesNo
If YES, please indicate your interest(s):

ShowsSpecial SkillsHobby/CraftsOther
Describe your skills/talents that can help the Club. For example: writer, artist, web design,etc.
Do you own other breeds?

YesNo
If YES, please identify breeds:
Indicate number of dogs owned and/or co-owned in each of the additional breeds:
Are you currently a member of an All-Breed, Group, or Specialty dog club(s)?

YesNo
Position(s) held:
If you are a breeder, do you sell all pet puppies requiring spay/neuter and on limited registration?

YesNoNot a Breeder
Please state how many litters (of each breed) were bred and whelped by you in the last 3 years and indicate whether you are owner or co-owner, and whether you were responsible for placing the puppies:
Are your dogs registered with the AKC?

YesNo
AKC titles won?
Have your AKC privileges ever been suspended or revoked?

YesNoNever been affiliated with AKC
If YES, please explain:
I agree to abide by the ATCA Code of Ethics

Yes
“I understand that membership in the Australian Terrier Club of Colorado is a privilege,not a right, and if membership should be denied, no reason will be given.”
Signature

Powered by Jotform SignClear
Applicant: (By signing electronically, you acknowledge that this is your legal signature.)
Date
Membership Type

Regular ($25)Junior (Ages 10-17) $20
Sponsors

Applicants must have two ATCC sponsors in good standing. (A separate form will be emailed upon completion of this application.)
Once you hit submit, there will be a link that will take you to our online store. You can select your membership option and pay online.

***PLEASE READ!!! We are using Zeffy for an online platform, which is 100% free. We receive ALL money. There is an optional "Tip", which funds the platform. You may change this amount to $0.00 if you do not wish to contribute to Zeffy. We do not receive any of the optional Tips.***

You may also mail a check payable to ATCC to:

Holly Ewing

405 7th St. NW

Altoona, IA 50009

(If you are mailing a check, you may close the browser after you submit the form)

Thank you!
Should be Empty:

Australian Terrier Club of Colorado Membership Application

Sponsors