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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: _________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

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 ____ Membership is non-refundable

Confirmed by Club Secretary __________________

Date Confirmed ___________________