MCOF Membership Application

MEMBERSHIP TYPE*

HOUSEHOLDSINGLEJUNIOR

Applicant NAME*

FIRST NAMELAST NAME

PHONE*

Country Code (If not USA)

E-MAIL*

example@example.com

MAILING ADDRESS*

CITY*

STATE*

ZIP CODE*

Country (If not USA)

DOB (MM/DD/YY)*

OCCUPATION*

SPOUSE

OTHER

PHONE

E-MAIL

example@example.com

DOB (MM/DD/YY)

OCCUPATION

Child #1 NAME Under the age if 18

DOB (MM/DD/YY)

Child #2 NAME Under the age of 18

DOB (MM/DD/YY)

Child #3 NAME Under the age of 18

DOB (MM/DD/YY)

Child #4 NAME Under the age of 18

DOB (MM/DD/YY)

MASTIFFS IN HOUSEHOLD AND THEIR NAMES*

LIST OTHER BREEDS IN HOUSEHOLD*

PLEASE INDICATE YOUR AREA OF INTEREST:*

ARE YOU A MEMBER OF THE MASTIFF CLUB OF AMERICA?*

YESNOPENDING

MCOF ENCOURAGES ALL MEMBERS TO BE ACTIVE AND ATTEND ALL GENERAL MEMBERSHIP MEETINGS WHEN POSSIBLE. PLEASE SELECT ALL AREAS YOU MAY WANT TO LEARN MORE ABOUT BEING A PART OF:*

PLEASE STATE IN YOUR OWN WORDS WHY YOU WANT TO BECOME A MEMBER*

WHO CAN WE THANK FOR REFERING YOU TO MCOF?*

PHOTO / VIDEO USE RELEASE

I, hereby grant and authorize the Mastiff Club of Florida the right to take, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me, my pets, and/or family to be used in and/or for legally promotional materials including, but not limited to newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits, and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing and submitted to the club’s President.

I understand and agree that these materials shall become the property of the Mastiff Club of Florida and will not be returned.

I hereby hold harmless, and release the Mastiff Club of Florida from all liability, petitions, and causes of action which I, my heirs, representatives, administrators, or any other persons may make while acting on my behalf.

I HAVE READ AND UNDERSTAND THE ELIGIBILITY REQUIREMENTS OF THE MASTIFF CLUB OF FLORIDA. I AGREE TO THE WAIVER & RISK AGREEMENT AND THE CODE OF ETHICS AND AGREE TO ABIDE BY THEM AS CONDITIONS OF MEMBERSHIP. SIGNATURE OF APPLICANT AND ANY ADULTS OVER THE AGE OF 18 LISTED IN HOUSEHOLD*

Date

MASTIFF CLUB OF FLORIDA MEMBERSHIP APPLICATION

Section I

SECTION II

Section III

Section IV

Section V

Section VI