Membership Application

Your Name:

Your Address:

Your Phone:

Your E-mail Address:

Occupations: :

Kennel Name

Are You Over 18 Years of age?

Do you Own A Japanese Chin at this time?

How Many Chin do you own

Are your Chin registered with American Kennel Club

Are your Chin individually identified

Tattoo Microchip etc

Have Your privileges ever been suspended by A.K.C. ?

Are you a Member of any other dog clubs

Is your business or immediate family members dog related

Are you willing to serve on a committee of The Chin Club

Are you willing to work for the advancement of the Japanese Chin good sportsmanship and best interest of the club?

Have you ever?

Exhibited Bred Judged

Indicate your areas of interest.(check all that apply)

Conformation? Obedience? Agility? Breeding Other

I THE UNDERSIGNED hereby apply for membership in the Japanese Chin Club of Western Pa

I agree to abide by the Constitution, By-Laws, rules, and regulations of the club and the American Kennel Club. I have Read and answered all questions above truthfully and fully. It is also understood that the sale of my puppies/dogs to a pet shop is cause for immediate dismissal from the club

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