Evergreen Shiba Inu Club
Membership Application I hereby make application for membership in the Evergreen Shiba Inu club.
I agree to abide by the Constitution & By-Laws and Code of Ethics of this club.
Name: ___________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
City:_____________________________________________________________________________________________________
Phone___________________ Kennel Name (if any)________________________________________________________________
Breeds owned: ____________________________________________________________________________________________
Other Breed Clubs you belong to:_______________________________________________________________________________
________________________________________________________________________________________________________
Have you ever been suspended by AKC or been subjected to discipline by a Breed Club?
No____ Yes ____ If Yes, please explain: ________________________________________________________________________
_________________________________________________________________________________________________________
Applicant's signature (s) _____________________________________________________
Date: ______________________________________________________
Membership Sponsor_______________________________________________________
Club Officer Sponsor________________________________________________________
Annual Dues: Individual $20.00 Family: $25.00
Submit application and fee to:
Evergreen Shiba Inu Club
Laura Perkinson
3104 Laurel Ln,
Centralia WA 98531
Make Checks Payable to: Evergreen Shiba Inu Club
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
General Membership Vote: For _______ Against ______
Accepted: ______ Rejected ______ Date: __________________________
Reason for rejection: ___________________________________________________________________________
____________________________________________________________________________________________
Membership Application I hereby make application for membership in the Evergreen Shiba Inu club.
I agree to abide by the Constitution & By-Laws and Code of Ethics of this club.
Name: ___________________________________________________________________________________________________
Address:_________________________________________________________________________________________________
City:_____________________________________________________________________________________________________
Phone___________________ Kennel Name (if any)________________________________________________________________
Breeds owned: ____________________________________________________________________________________________
Other Breed Clubs you belong to:_______________________________________________________________________________
________________________________________________________________________________________________________
Have you ever been suspended by AKC or been subjected to discipline by a Breed Club?
No____ Yes ____ If Yes, please explain: ________________________________________________________________________
_________________________________________________________________________________________________________
Applicant's signature (s) _____________________________________________________
Date: ______________________________________________________
Membership Sponsor_______________________________________________________
Club Officer Sponsor________________________________________________________
Annual Dues: Individual $20.00 Family: $25.00
Submit application and fee to:
Evergreen Shiba Inu Club
Laura Perkinson
3104 Laurel Ln,
Centralia WA 98531
Make Checks Payable to: Evergreen Shiba Inu Club
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
General Membership Vote: For _______ Against ______
Accepted: ______ Rejected ______ Date: __________________________
Reason for rejection: ___________________________________________________________________________
____________________________________________________________________________________________
