MEMBERSHIP APPLICATION Name ___________________________ Type of Membership __Family __Single __Junior (check one) Spouse _______________________________________ Address _________________________________City __________________ Zip code __________ Occupation ________________________________________________________ (optional) E-Mail Address _____________________________________ Phone Number _________________________ Family Members and ages: __________________________________________________________________ Name of Dog ________________________________Breed ___________________ Age ______ Name of Dog ________________________________ Breed ___________________ Age ______ Name of Dog ________________________________ Breed ___________________ Age ______ (If more than three use back of sheet. Please indicate if UKC reg. for each dog) Area of Interest ___ Agility ___ Obedience (check all that apply) ___ Conformation ___ Field Areas you can help in. Example Stewarding, ring setup, teardown, clean-up entries, computer work, etc. _______________________________________________________________________________ Are you licensed to Judge UKC events. ____Yes ____ No If yes please list the type of events. ___________________________________________________________________________________ Memberships will run from January to December. Memberships dues are $15.00 Single $25.00 Family $10.00 Junior Members 1 vote 2 votes (no votes) By signing below I agree to abide by the by-laws of the club in conjunction with The United Kennel Club. Membership in this club in no way affects your membership with any other organization except the United Kennel Club. Mail membership dues and application to Michele Panetta 3963 NW 18 Ave. Oakland Park Florida 33309 Make Check out to Michele Panetta. Please write UKC MEMBERSHIP on lower left corner. Her account will be used until a checking account is opened. _____________________________________________________ Signature Date ____________________________________________________ Signature Date