Conewango Valley Kennel Club

Application for Membership

Name: __________________________________________________

Address: __________________________________________________

__________________________________________________

Phone: ______________________ Fax: ______________________

E-mail: __________________________________________________

Kennel Name: ______________________________________________

Number of dogs owned at present: ____ (Use back if needed)

Name Breed AKC# ___________________________________________________________

___________________________________________________________
___________________________________________________________

What dog-related experience have you had?__________________

___________________________________________________________

Clubs of which you are/were a member and offices held:

___________________________________________________________

List any litters you have bred in the last three years:

___________________________________________________________

List any stud services provided in the ;ast three years: ___________________________________________________________

Are you interested in the following activities:

Conformation ______________ Handling ____________

Judging _____ _________ Obedience ____________

Agility ______________ Lure Coursing ____________

Field Trials ______________ Earth Dog ____________

Herding ______________ Tracking ____________

C.G.C/Therapy Dog __________ Other ____________

Do you sell to retail or wholesale outlets? _______________

Have you ever been suspended from AKC privileges? _________

If yes, give details: _____________________________________

What do you wish to achieve by joining the C.V.K.C.?

___________________________________________________________

I certify that all of the above statements are true.

Signature: ________________________________________________

Date: ________________________________________________

Sponsor: __________________________________________________