Membership application

Please read and answer all questions, (type or print clearly)

NAME:_______________________________________________________________________________

ADDRESS:____________________________________________________________________________

CITY: ________________________________ STATE: ____________________ ZIP: ________________

PHONE: (______) ________________________________ BUS: (_____) __________________________

FAX: (_____) ___________________________________ EMAIL: _______________________________

OCCUPATION: ________________________________ KENNEL NAME: _______________________

Are you in good standing with the American Kennel Club? YES______ NO______

Are you a Member of the Miniature Pinscher Club of America? YES_____ NO______

Have you ever been suspended by AKC or any of the above Clubs? _______________________________

(If yes, please attach a separate sheet with an explanation)

How long and in what capacity have you been involved in purebred dogs?__________________________

_____________________________________________________________________________________

What are your areas of interest? Pet _______ Breeding _______ Conformation_______

Obedience _______ Agility _______ Other (i.e. therapy dogs etc) ________

What other breed (s) do you own now or have you owned in the past? _____________________________

_____________________________________________________________________________________

How many Miniature Pinschers do you own at this time? _______________________________________

_____________________________________________________________________________________

Please provide the name and address of person from whom you obtained your last Miniature Pinscher

(other than your own breeding): ____________________________________________________________

_____________________________________________________________________________________

How many litters (all breeds) have you bred in the last five (5) years? _____________________________

How many litters of Miniature Pinschers have you bred in the past 5 years? _________________________

Have you earned AKC Championships or Obedience titles on the dogs owned by you? ________________

Please attach a separate page for explanation if you answer yes to either of the next two questions

1. Are you, or any member of your immediate family, involved in a commercial kennel, pet shop, or grooming shop that sells dogs? ____________

2. Do you, or any member of your immediate family, buy or sell litters or individual dogs for resale? ________

Why do you want to become a member of the Pacific Northwest Miniature Pinscher Club? ____________

_____________________________________________________________________________________

Membership fees are $10 per year, for a regular membership, which includes voting privileges, and member lives within the prescribed area.

Associate Membership fees are $5 per year, and do not include voting privileges.

I,(We), the undersigned apply for:______ Regular Membership in the Pacific Northwest Miniature Pinscher Club, ______Associate Membership in the Pacific Northwest Miniature Pinscher Club. If accepted for membership, I will comply with the Code of Ethics of the MPCA. With your application include a signed copy of the MPCA Code of Ethics.

______________________________________ _______________________________________

Applicant Signature: Date:

______________________________________ _______________________________________

Sponsor Signature: Date:

______________________________________ _______________________________________

Sponsor Signature: Date: