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MID-ATLANTIC HOUND ASSOCIATION

of Central North Carolina

Membership Application

NAME(S):

ADDRESS:                                 

CITY:

STATE:                                                 ZIP CODE:

TELEPHONE:                                                                                         E-MAIL:

OCCUPATION:

TYPE OF MEMBERSHIP (circle one):

Household ($15 per applicant first-year dues; thereafter, dues are $15 for first member plus $5 for each additional member.)

Individual ($15)

Junior ($5)

BREED(S) OF HOUND(S) OWNER:

INTERESTS:

Conformation                 Obedience                Performance Events (List)_________________________________

BRIEF HISTORY OF YOUR AFFLIATION AND ACTIVITIES WITH HOUNDS:

 

IF YOU CURRENTLY ARE A MEMBER OF ANY OTHER DOG CLUB OR ORGANIZATION,

PLEASE LIST AND INCLUDE HISTORY OF YOUR PARTICIPATION IN EACH CLUB (i.e. offices or responsibilities held):

ARE YOU A (circle):                 BREEDER                 EXHIBITOR                  INTERESTED DOG OWNER

ARE YOU INTERESTED IN PARTICIPATING IN BREED RESCUE?         IF SO, LIST WHICH BREED(S):

 

 

I/We agree to abide by the by-laws of the Mid-Atlantic Hound Association of Central North Carolina (MAHA/CNC) and of The American Kennel Club.

Signature

Signature

Date

MEMBERSHIPS ARE ANNUAL -  PLEASE SEND COMPLETED FORM TO:

David Raper, Treasurer

1718 Trinity Road, Raleigh, NC 27607-4920

or

Gail Boyd, Membership Chair

8948 Hope Hill Lane, Apex, NC 27502-7845

Signatures of two sponsoring members are required:

Signature ______________________________

Please print name ____________________________

Signature _____________________________

Please print name ____________________________

 

TO BE FILLED OUT BY A MAHA MEMBER: Application fee in the amount of $ ____

(cash_____ or check _____ ) received by (signature) __________________________.

Please be sure this application and the membership fee are submitted to the

Secretary, Treasurer, or Membership Chair.

 
 
 
Download application below:  
ĉ
Deana McNamer,
Dec 26, 2010, 1:56 PM