Black Russian Terrier Club of Northern New Jersey

New Membership Application

NAME_____________________________________________DATE______________________
NAME_______________________________________________________________________
(List two household members if you choose a household membership as each member
has a vote. Only one member may hold office.)
ADDRESS________________________________________City_________________________
STATE/COUNTRY/ZIP CODE______________________________________________________
PHONE___________________________________FAX_________________________________
E-MAIL______________________________________________________________________
Kennel Name_________________________________________________________________
 
Do you approve of your contact information being posted on the BRTCNJ:  Web-site: Yes ( ) No ( ) Newsletter: Yes ( ) No ( )
 
List other All-breed or Specialty Clubs to which you now belong and offices held (if any).
_____________________________________________________________________________

Owner of how many Black Russian Terriers?____________________________________________
Co-owner of how many Black Russian Terriers?_________________________________________

 

If elected to membership, will you be willing to serve on a committee(s)? (  ) Yes (  ) No
Please check the Committee(s) on which you would be interested in working.
Advertising/Catalog____ Historian/Librarian______ Picnic______ Audio/Photography______ Judging Committee_______ Match Show______ Public Education______ Budget________ Publicity______Trophies_______ Sunshine______ Membership______Club Property_______ Newsletter______ Fund Raising_______Rescue________

I have read and agreed with the code of ethics  Yes (    )    No (   )

If elected to membership, I hereby agree to abide by the Constitution,By -Laws and the Code of Ethics of the Black Russian Terrier Club of Northern New Jersey and the Rules and Regulations of the American Kennel Club


_____________________________________________________________________________
Signature of Applicant                                                             Date

Circle appropriate Membership

Regular Membership - Individual $25
Household Membership $50
Associate Membership $15
Overseas Membership $25 plus shipping & Handling

Your membership fees will be deposited upon the acceptance of your membership. Payment must be made in U.S. Funds.

Application Received by Membership Chairperson_________________

Has applicant met three service requirement _________________

Is application complete with sponsorship__________________________
Read Application at Meeting _________________________________
Voted on_____________________________________________________