Samoyed Club of Washington State Membership Application Form

Samoyed Club of Washington State Membership Application

To apply for membership please complete all questions. If renewing membership, please complete first section only. Thank you!
Name

First NameLast Name
Additional Applicant Name (Family/Household Membership)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary E-mail
example@example.com
Second Applicant Email
example@example.com
Cellular Number
Format: (000) 000-0000.
My Products
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Individual Membership
$20.00



Family Membership
$25.00



Prepaid Membership
Free Quantity



Total

$0.00
New Membership Applicants please complete information below.

Not required for membership renewal
Areas of Interest (select all that apply):

Other
Areas of Involvement:
How many Samoyeds do you own or co-own?
Samoyed Ownership Information – AKC Registered Name
Call Name
Age/Gender of dog
Breeder:
Samoyed Ownership Information – AKC Registered Name
Call Name
Age/Gender of dog
Breeder:
Samoyed Ownership Information – AKC Registered Name
Call Name
Age/Gender of dog
Breeder:
Sponsor #1
Sponsor #1 Email
example@example.com
Sponsor #2
Sponsor #2 Email
example@example.com
I /We hereby apply for membership in the Samoyed Club of Washington State. I/We agree to abide by the Club Constitution and its Code of Ethics. My/Our compliance to the Code of Ethics is confirmed by my/our signature(s) on the Code of Ethics page. I/We agree to abide by the Rules and Regulations of the American Kennel Club.
Signature
Signature of second applicant
Date of Signature

MonthDayYear
Date
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Samoyed Club of Washington State Membership Application

My Products

New Membership Applicants please complete information below.

Payment Methods