INSTRUCTIONS FOR COMPLETING A MEMBERSHIP APPLICATION
* Each person applying for membership in the Club must be at least 18 years old and must fill-out their own application. Single applications submitted for multiple individuals (such as a husband and wife), will not be accepted.
* All entries on the application form must be completed. Mark “NA” for those entries that are not applicable.
* Applications should be filled out by either typing or printing clearly using a dark pen.
* Applications must include the signatures of the two YPDC members who are sponsoring the applicant.
* The sponsors’ letters of recommendation may be submitted either in hard copy format (typed or clearly written in ink) or via email to the Membership Chair.
* Incomplete applications will be returned to the applicant for correction.
* First year membership dues of $30 and a non-refundable application processing fee of $10 must be included with the application. Subscriber membership dues are $30.00 per year, with no application processing fee needed. Do not send cash. Checks or money orders should be made payable to the Yankee Pug Dog Club.
* Properly completed applications and accompanying payment should be mailed to the YPDC Membership Chairman as indicated on the application form for processing.
NOTE:
Subscriber: No sponsors needed. Please do not fill in the sponsor information in the application. Dues for Subscriber Membership is $30.00 a year.
New Members: Must attend two club meetings before being voted in as a member. Upon submission of the application, the applicant will receive the Club Newsletter which will include the date and place of the next scheduled meeting. Yankee Pug Dog Club Policies: A member is expected to attend at least three club functions a year. If elected to membership I agree to abide by the constitution and by-laws of the Yankee Pug Dog Club. I also agree not to sell any puppies to Pet Shops or in Litter Lots.
Yankee Pug Dog Club
MEMBERSHIP APPLICATION
All items must be completed.
Mark N/A” for those not applicable
** Incomplete applications will be returned **
Applicants must be at least 18 years old, and each member of a household must complete their own application
**PLEASE PRINT IN INK OR TYPE**
Date _________________
Membership Sought: Member___________ or Subscriber_______________ (select one)
Name ______________________________________________________________________________
Address ___________________________________________________________________________ City_____________________________________State_________________Zip__________________ Home Phone_____________________E-Mail ____________________________________________ Cell Phone _____________________________________
Pug Information:
Do you own a Pug? Yes No How many? ______Number of years you have been involved with this breed? _____________
Do you also Exhibit your Pug?
Conformation_________Obedience ___________Agility_______Rally ___________Other________
Are you a Pug Breeder? Yes No
Breeding experience: (I have / have not) had a litter.
How many litters have you registered?____________
Do you have a kennel name? Yes_____ No _____ Is it registered? Yes___No ____
If yes, what is it? ______________________________________________________
General Information:
Are you now, or have you ever been suspended from the privileges of the AKC? Yes ___ No____
If Yes, When and Why? ______________________________________________________________
Have you or a member of your household ever been charged with animal cruelty? Yes___ No ___ If Yes
Describe the circumstances: _____________________________________________________________
Have you ever been the subject of an AKC Bench Show Hearing? Yes____No_____ If Yes, What was the outcome? ___________________________________________________________________________
Have you been a Yankee Pug Dog Club before? Yes ____No ____If Yes, what year (s)? ___________
Have you ever applied to this or any Pug Club for membership and been denied? Yes ____ No ____
If Yes, When and Why? _______________________________________________________________
Are you now, or have you ever been a member of any Dog Club? Yes ____ No ____
If so, please state names of clubs, dates of membership, offices held:
YPDC Committee Interests: (Circle at least three)
Fund raising Newsletter Internet Watch Membership Committee Rescue Trophies
AKC Match Publicity Other
Indicate which Committee(s) you will serve on: _________________________________
Please provide the names of several people identified with our Breed with whom you are acquainted:
How do you plan to help the Breed and the Club? Briefly describe your interest in Pugs and your reasons for seeking YPDC Membership:
Sponsor Information:
TWO YPDC MEMBERS IN GOOD STANDING MUST SIGN EACH APPLICATION
The following members of YPDC sponsor me for membership:
_______________________________________ ________________________________________
Sponsor’s Signature Sponsor’s Signature
Print Sponsor Name Print Sponsor Name
• I hereby apply for membership in the Yankee Pug Dog Club; certify that I am at least 18 years old; and if accepted, I agree to abide by the Club’s By-Laws, and the Rules and Regulations of the American Kennel Club.
• I have enclosed my first year’s membership dues of $30.00 and a $10 non-refundable application processing fee, or $30.00 for subscriber membership.
Applicant’s Signature Date
Please make checks payable to the Yankee Pug Dog Club
Mail your payment and application to:
Claire Burchfield
YPDC Membership Chairman
55 Windy Hill Rd. Hampton, CT 06247
Contact Claire for further instructions at: cburchfield@charter.net
FOR CLUB USE ONLY
Date Rec’d
Amount of Ck
Check #
Date to Treasurer
Date Approved *Yankee Pug Dog Club Membership/Subscriber Annual Renewal*
