memberapp

DELAWARE VALLEY HAVANESE CLUB MEMBERSHIP APPLICATION

PLEASE PRINT

Complete the application below and send it with the appropriate fees to:

Chairperson Membership Committee

Mary Lou Mitchell

3549 Woodcrest Ave.

Newtown Square, Pa. 19073

Please note that it will take several months for final approval inasmuch as each applicant must be "read" and then voted on at club meetings. Meanwhile, however, we shall place you on the email list so you can keep up with news, views and events.

Date:_____________________________

NAME: ____________________________________________________________

ADDRESS: _________________________________________________________

CITY: ________________________________STATE: ____ZIP:_____________

PHONE: ( )______________E-MAIL:_________________________________

OCCUPATION: _____________________________________________________

Regular and household members are entitled to vote and hold office. Regular

membership is for an individual and carries 1 vote. Household membership is open to those living at the same domicile who bear an immediate familial relationship to each other, and carries 2 votes. An associate member is someone between 11 and 18 years old, or who does not own a Havanese, or who chooses not to become a regular or household member. An associate member cannot vote or hold office and does not require any sponsors. If at a later date should you decide to become a regular member, it would be then you would need sponsorship. Hopefully by that time we shall have had a chance to get to know you better at the meetings.

ANNUAL MEMBERSHIP DUES: REGULAR: _____$25.00 HOUSEHOLD: ____ $30.00

ASSOCIATE: _____$15.00

REGISTERED NAMES OF HAVANESE YOU OWN OR CO-OWN:

DOGS NAME________________________________REG #_____________________

DOGS NAME________________________________REG#______________________

Please use back of application for additional names and registration numbers.

WHERE DID YOU ACQUIRE OR PURCHASE YOUR HAVANESE?

I AM INTERESTED IN: OBEDIENCE_____ EXHIBITING_____ AGILITY _____

BREEDING ______ OTHER ______________________________________________

WHAT PRELIMINARY HEALTH TESTING WILL BE PERFORMED BEFORE YOU BREED YOUR DOG? _______________________________________________

_______________________________________________________________________

OTHER BREED OF DOG YOU OWN. ___________________________

HAVE YOU BRED OR SHOWN DOGS BEFORE? __________________________

PLEASE LIST ANY DOG CLUB IN WHICH YOU ARE OR HAVE BEEN A MEMBER, AND THE APPROXIMATE LENGTH OF TIME IN EACH CLUB.

NAME: ______________________________________________YRS ___________

DO YOU HAVE ANY SKILLS OR EXPERIENCE YOU COULD SHARE WITH OUR CLUB?

WE APPRECIATE ANY HELP YOU COULD GIVE. WOULD YOU CONSIDER WORKING ON ONE OF THE COMMITTEES? _____________________________

I AM IN GOOD STANDING WITH THE AKC. I AGREE TO ABIDE BY THEDVHC CONSTITUTION AND BY-LAWS AND THE RULES OF THE AKC.

CANADIAN RESIDENTS MAY REPLACE AKC WITH CKC AND ARE ONLY ELIGIBLE FOR AN ASSOCIATE MEMBERSHIP STATUS.

I HAVE ANSWERED ALL THE ABOVE QUESTIONS TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. I AM AWARE THAT NOT HAVING DONE

SO WILL RESULT IN THE IMMEDIATE TERMINATION OF MY MEMBERSHIP.

SIGNATURE: __________________________________________DATE: __________

TWO MEMBERS IN GOOD STANDING (BOTH NOT FROM THE SAME HOUSEHOLD) MUST ENDORSE THE APPLICANT. PLEASE HAVE YOUR SPONSORS SIGN AND RETURN THE ENCLOSED FORMS. THIS IS IMPORTANT. WE CANNOT PROCESS YOUR APPLICATION WITHOUT SPONSORS IF YOU ARE APPLYING FOR A REGULAR OR FAMILY MEMBERSHIP. PLEASE DOWNLOAD THE SPONSOR ENDORSEMENT FORMS WITH THIS APPLICATION.

AN INCOMPLETE APPLICATION WILL BE RETURNED.

PLEASE ENCLOSE YOUR CHECK PAYABLE TO DVHC

AS DVHC MEMBER, I PREFER TO RECEIVE CLUB MAIL BY E-MAIL ___

OR U.S. POSTAL SERVICE _______

All applications become the property of DVHC, Inc.