MEMBERSHIP APPLICATION/RENEWAL
Personal Information Required
Type of Membership: New_____ Renewal_______
Single:___($20.00) Double:___($25.00) Family:___($35.00)
US membership is payable in US dollars
Applicant’s Name(s):____________________________________________________________
Address:______________________________________ City:___________________________
Province:_________________________ PostalCode:__________________________________
Tel:_(_____)______________FaxNo.:_(_____)____________Email:______________________
_____________________________________________________________________________
The following information is optional.
Kennel Name:_________________________________________________________________
CKC Membership #:_________________________ Tattoo Combination:___________________
Your personal involvement in Pomeranians consists of: (check all applicable activities)
Pet:______ Breeding:______ Conformation Showing:______ Obedience Showing:_____
Therapy:______ Agility:______ Flyball:______ Other:______
What skills can you offer the Club?_________________________________________________
DECLARATION:
I/We agree to abide by the Constitution and By-Laws of the Pomeranian Club of Ontario and the Canadian Kennel Club
I/We further agree that The Pomeranian Club of Ontario may include the following information in the membership list published on the Pomeranian Club of Ontario website.
| My/our name(s): Yes___ No___ | Kennel name: Yes___ No___ | Address: Yes___ No___ |
| Telephone No.: Yes___ No___ | Fax No.: Yes___ No___ | Email: Yes___ No___ |
| Tattoo Combination: Yes___ No___ | Puppy Referrals: Yes___ No___ |
Date: ________________________________ Signature(s)____________________________
Do not send cash. Please make cheque/money-order payable to The Pomeranian Club of
Ontario. Send your signed application with the appropriate dues to the Secretary:
Christine Surtees, R.R. #4, Almonte, Ontario K0A 1A0