Name: __________________________________________________ Date: ______________

Address: _____________________________________________________________________

______________________________________________________________________________

Phone: _____________________________ Cell: ____________________________________

Email: [email protected]____________________________________

Occupation: ______________________________________________________________________________

Current breed(s) owned: ______________________________________________________________________________

______________________________________________________________________________

Other pet(s) owned: ______________________________________________________________________________

Do you properly maintain your pet(s) health & condition? ______________________________________________________________________________

Do you have a copy of the constitution, by-laws and code of ethics of the Agathon Kennel Club? Yes__________ No___________

Do you promise to abide by the constitution, by-laws and code of ethics of the Agathon Kennel Club? Yes__________ No___________

______________________________________________________________________________

List any other kennel club or obedience club affiliations: ____________________________________________________________________________________________________________________________________________________________

Two (2) current member endorsements:

1.____________________________________________________________________________

2.____________________________________________________________________________

Please address any questions you may have: ______________________________________________________________________________

Signature: ______________________________________________________________________________

********** For club use only **********

Applicant attended membership meetings on the following dates:

1.___________________________________2._________________________________

Date application was presented to and reviewed by the board: __________________________

Date application read to membership and presented to vote: ___________________________

Approved: Yes_________ No___________