Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Alt. Phone

(###)

###

####

Spouses Name

First Name

Last Name

Interests: *

Obedience

Tracking

Field Trials

Agility

Family Pet

Therapy Dogs

Other

Application For: *

Family membership includes all children under 18 years of age, however children under 18 are not eligible to vote.

Individual Membership ($15)

Family Membership ($20)

Dues: *

I understand dues must be paid in full at the first general meeting/first reading of the application. If submitted after June 30th, dues are one-half the full amount.

Agree - will bring to the first meeting

Disagree

Requirements: *

I (we) agree to abide by the Constitution, Code of Ethics, and By-Laws of The Lawrence Jayhawk Kennel Club, as well as by the rules of the American Kennel Club.

Agree

Disagree

Electronic Signature *

First Name

Last Name

Sponsoring Club Member #1

First Name

Last Name

Sponsoring Club Member #2

First Name

Last Name