Name(s)_______________________________________________________________________________

Address_______________________________________________________________________________

Phone (hm) ________________________ (wk) _____________________ (FAX) ___________________

E-mail address ___________________________________Kennel Name  _______________________

Dog Information:

Name(s)  __________________________________________________________

______________________________________________________________________________________

AKC Number(s)  _______________________________________________________________________

Date(s) of Birth  _______________________________________________________________________

Gender(s)  ____________________________________________________________________________

Breeder(s) ____________________________________________________________________________

Interests:         _____________  Field _____________  Conformation  _____________  Obedience _____________  Other

Dues:________ $30 Single ________ $35 Family____________For Member Chair below:Paid CK#__________

Sponsors:        Sponsorship by two club members required

(1) _________________________________   (2) _______________________________

Notice:  No moneys will be refunded unless your membership is rejected by SVLRC. The person(s) whose membership is applied for must notify the Membership Chair when the membership requirements are met before a vote will be taken at a General Membership Meeting of the Sierra Vista Labrador Retriever Club.  Each applicant must attend one club function (other than the Club's Specialty Match/Show, unless you assist or work at this function) within 6 months of rendering application to Membership Chair.

I, have read and, agree to abide by the Constitution, By-Laws, and Breeder's Code of Ethics of the Sierra Vista Labrador Retriever Club, and I agree to abide by the rules of the American Kennel Club.

Signature ______________________________________  Date  ____________________

Signature ______________________________________  Date  ____________________