Membership application

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Membership Application


Name(s) ____________________________________________________________________


City______________________________________ State________ Zip Code______________

Telephone #________________E-mail Address________________________________________

  1. Do you plan to attend the monthly meetings? Yes__________ No__________
  2. How do you prefer to serve the club? Committee_____ Dog shows/matches_____

Officer_____ Special skills_____ (please specify) ____________________________

Other_____ (please specify) ________________________________

3. Are you currently a member of another kennel or breed club? Yes_____ No_____

If yes, please list________________________________________________________


4. Please list the breed(s) you own/work with: ________________________________

____________________, ____________________, ____________________

5. Do you breed or plan to breed AKC registered dogs? Breed now______,

Have bred______, Do not breed______, Undecided______.

6. Do you show?

  • Agility: Show___, Have shown___, Do not show___, Undecided___
  • Conformation: Show___, Have shown___, Do not show___, Undecided___
  • Obedience: Show___, Have shown___, Do not show___, Undecided___
  • Hunting/Field Trials: Show___, Have shown___, Do not show___, Undecided___

Please tell us about yourself: ____________________________________________________



Please list your veterinarian: ____________________________ Telephone #________________

Membership dues are $20.00 for a family and $15.00 for a single. Cash_________ Check # and amount__________________________________. ***There is a one time fee of $10.00


I/we have read and understood the Constitution and By-laws and Code of Ethics and agree to abide by them. I/we agree to not hold the CAKC or any of it’s’ members responsible for any liability or injury incurred at any event held or sponsored by this club.

Signature: __________________________________ Signature: _________________________________


Sponsored by (club member):___________________________________


Approved: Yes___ No___ Date: __________ Signed by: __________________________________