Evergreen Shiba Inu Club
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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
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General Membership Vote: For  _______  Against  ______

Accepted:  ______  Rejected  ______  Date: __________________________


Reason for rejection: ___________________________________________________________________________

____________________________________________________________________________________________




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