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(1)_____________________________Nick Name ____________ (2)_____________________________Nick Name ____________ Address: _______________________________ e-mail: _______________________ Tel. No.: Home ___________Work: (1) ________________(2) _________________ Occupation & Company: Elkhounds Owned: Name & Location of your Veterinarian: _____________________________ _____________________________________________________________ Other Animals owned - Dogs, Cats, Birds, etc.: ____________________________ _____________________________________________________________ _____________________________________________________________ Please Indicate your interest in the following by checking all that apply: If you have already participated in any, please circle your check mark.
Would you be willing to assist the Club at sometime in any of the following
Would you be willing in the future to run for a Club Office: ________Yes Membership in other Canine Club(s). List names and positions held (if any): _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ How long have you been interested in the Norwegian Elkhound Breed: ___ What are some of your other interests and hobbies: (Please, for a family membership indicate whose interest - applicant 1 and/or 2) _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Certification of Applicant(s) I (We) hereby apply for membership in the Norwegian Elkhound Club of the Potomac Valley. If accepted, I (we) agree to abide by the Constitution, By-Laws, and Code of Ethics of the Club and the Rules of the American Kennel Club. Signed: __________________________________ Date: _______________ Signed: __________________________________ Date: _______________ Attached is my/our check (to NECPV) in the amount of $_______($20 Family, $12.50 Single per year) Proposer’s signature: ________________________ Date: ______________ (Club Member) Proposer’s signature: ________________________ Date: ______________ (Club Member or your Veterinarian) Please send completed form to: NECPV Membership Director, 14613 Antler Road, Fredericksburg, VA 24701-1592. Any questions? contact: Gledene@aol.com. |