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Port Arthur Retriever Club
Application for Membership
NAME:
	Last			First			Middle
SPOUSE'S NAME:				EMAIL:
HOME ADDRESS:
CITY:				STATE:		ZIP:
MAILING ADDRESS						PHONE:
AGE		OCCUPATION				D.L. #
HAVE YOU EVER BEEN A MEMBER OF THE PORT ARTHUR RETRIEVER CLUB?
IF YES, WHAT YEAR?    ___________				DO YOU CURRENTLY OWN A RETRIEVER?
WHAT BREED?			SEX			COLOR
WHY DO YOU WANT TO JOIN PARC?
HOBBIES OR SPECIAL INTERESTS:
DO YOU PLAN TO ATTEND HUNT TESTS OR FIELD TRIALS?							PLEASE SPECIFY
WOULD YOU BE WILLING TO HELP AT ONE OF THE HUNT TESTS OR FIELD TRIALS SPONSORED BY THE PORT ARTHUR RETRIEVER CLUB?    YES    NO
OCCASIONALLY WE ARE ASKED FOR A MAILING LIST OF CLUB MEMBERS SO THAT A COMPANY MAY SEND A CATALOG OR PROMOTION.  DO YOU WANT THE CLUB TO INCLUDE YOUR NAME ON THIS LIST?  YES      NO
IF ACCEPTED AS A MEMBER, I AGREE TO ABIDE BY THE CONSTITUTION AND BY-LAWS OF THE PORT ARTHUR RETRIEVER CLUB, THE RULES OF THE AMERICAN KENNEL CLUB, AND ALL PROVISIONS OF THE CLUB'S LEASE PROPERTY.
				APPLICANT'S SIGNATURE				DATE
				ENDORSING MEMBER'S SIGNATURE				DATE