Waterloo Amateur Retriever Club Membership Form

Name       ______________________________________________________________
Address  _______________________________________________________________
City        __________________________ State   _________     Zip Code  __________

Telephone         (____) _____ - ________ Home
                        (____) _____ - ________ Office

E-mail ______________________________________________

List of dogs you own: (Names and breed)
1. ___________________________        5. _________________________
2. ___________________________        6. _________________________
3. ___________________________        7. _________________________
4. ___________________________        8. _________________________

What activities are you looking forward to participating in?
AGILITY           (EVENTS   ______, SEMINARS ______, TRAINING ______ )
FIELD               (TRIALS    ______, SEMINARS ______, TRAINING ______ )
HUNT              (TESTS     ______, SEMINARS ______, TRAINING ______ )
OBEDIENCE        (EVENTS   ______, SEMINARS ______, TRAINING ______ )

AKC Designation: (Check all that apply to you)   Dog Owner __ Breeder __ Exhibitor __

Have you titled a dog? If so, what titles have you obtained?
_________________________________________________________________________________
_________________________________________________________________________________
Please give a brief description of what your main objectives are for joining this club -
what you expect to contribute to the club and what you expect to gain from being a
member of this club.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What other dog clubs have you been a member of or are currently associated with?
_________________________________________________________________________________
_________________________________________________________________________________
Have you ever been suspended from the AKC? _____ If yes, please explain.
_________________________________________________________________________________
_________________________________________________________________________________

(Please review and acknowledge the Code of Ethics.)