AUTUMN VALLEY GOLDEN RETRIEVER CLUB OF THE SOUTHERN TIER
P.O. BOX 779
VESTAL, NY 13850
NEW MEMBERSHIP APPLICATION
Date of Application __________________
Family Members ______________
Name ______________________________
_____________________________
Address ____________________________
_____________________________
___________________________________
Occupation(s) _________________
Phone: Home (____)__________________
No. of Goldens ______ Other dogs
Work (____)____________
______________________________
Email ______________________________
List of Dog Organizations you belong to
or have belonged to: ________________________________________________________________________
Kennel Services Rendered: ________________________________________________________________________
Have you shown at any Point Shows,
Obedience, Agility, Field Trials or Sanctioned Matches? If so, name at least two: __________________________________
___________________________________
References: (Vets)
________________________________________ _____________________________________________
________________________________________ _____________________________________________
Sponsors Approval:
1)
______________________________________
2)
______________________________________
I have received a copy of the
Constitutions, By-Laws and Code of Ethics: _________
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Bottom to be filled out by Club
Officers
Must attend at least 2 meetings and
will be voted on at the third meeting.
Date of meetings attended
1) ____________________ 2) __________________
Individual - - - - $20.00 ____
Family
- - - - $25.00 ____
Confirmed by Club Secretary __________________
Date Confirmed ___________________