APPPC Membership Application

First and Last Name *

Mailing Address, (Street) *

City *

State *

Zip Code *

Phone number *

E-mail address *

Today's date: *

Kennel Name

Number and type of Pequenos owned *

Pequenos acquired from:

Other dogs owned *

Have you ever been convicted of any charge involving an animal? *

Yes No

Applicant(s) Occupation *

I (we) wish to join APPPC because: *

Other Kennel Clubs and Dog Affiliations *

I (we) are interested in a: SINGLE MEMBERSHIP ($20) *

Yes No

FAMILY MEMBERSHIP ($30) *

Yes No

Honorary Membership (FREE) - Non-Voting *

Yes No

JUNIOR MEMBERSHIP (FREE)* NO Voting Privileges* *

Yes No

I (we) agree to abide by the American Portuguese Podengo Pequeno Club’s Code of Ethics. I (we) have reviewed APPPC’s Code of Ethics and agree to abide by same. I (we) am/are at least 18 years of age. *

Yes No

If applying for Junior Membership a parent or legal guardian must co-sign application. *

Yes No

Signature of Applicant *

Signature of Applicant

By submitting this form electronically, you agree that your signature is valid. *

True False

I agree to receive information, newsletters, correspondence and ballots Electronically *

Yes No