Membership Application

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Printable Membership Application for the Berrien Kennel Club.

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First Reading ________________ 
Second Reading _____________ 
Third Reading _______________ 
 

Berrien Kennel Club 
Application for Membership 

Please Print 
 
Name _________________________________________________________________________________________ 
                                    (Last)                                             (First) 
Address ______________________________________________________________________________________ 
City ___________________________________ State _________________________ Zip Code ____________ 
Phone Number ______________________________________________________________________________ 
Email _________________________________________________________________________________________ 
Occupation ___________________________________________________________________________________ 
List the breed(s) you have owned __________________________________________________________ 
_________________________________________________________________________________________________ 
How many litters have you registered with the American Kennel Club? _________ 
How many dogs you do currently own or co‐own? ___________________________________ 
About how many shows and/or performance trials do you attend per year? 
Number of shows _______    None, I am in the process of learning _______ 
Please describe your kennel facilities ______________________________________________________ 
 
 
_________________________________________________________________________________________________ 
 
_________________________________________________________________________________________________ 
Have you ever been a member of a dog club? Yes ______  No ______ 
Are you currently active? Yes ______  No ______ 
If yes, please list the clubs and indicate if you have been an officer in that club 
 
_________________________________________________________________________________________________ 
 
_________________________________________________________________________________________________ 
 
_________________________________________________________________________________________________ 
Have you ever been suspended from the privileges of the American Kennel Club? 
Yes ______ No ______ 
 
What category best describes your involvement in dogs? Check each that applies. 
 
Exhibitor _____ Breeder _____ Pet Owner _____ Kennel Operator _____ Hobby _____ 
Grooming _____ Pet Shop _____ Professional Handler _____ Judge _____ Other _____ 

REFERENCES: Please list 3 references with their addresses & phone numbers. 
Preferably 2 references are exhibitors and/or connected with purebred dogs in 
some manner. 
1) ____________________________________________________________________________________________ 
  
________________________________________________________________________________________________ 
 
2) _____________________________________________________________________________________________ 
 
________________________________________________________________________________________________ 
 
3) _____________________________________________________________________________________________ 
 
________________________________________________________________________________________________ 
 
TERMS & CONDITIONS OF MEMBERSHIP 
 
I hereby agree that if membership to the Berrien Kennel Club is granted to me,  
1. I shall abide by and be governed by the rules and regulations of the 
American Kennel Club. 
2. I shall be an active participant in the Berrien Kennel Club activities and 
projects. 
3. I shall abide by the terms and conditions set forth in the Constitution and 
By‐Laws of the Berrien Kennel Club. 
4. I understand that there may be an in‐home interview with a kennel 
inspector of my facilities by the membership committee prior to my third 
meeting. 
 
I have read the above terms and understand them fully. Being in agreement and 
with my signature, I do hereby apply for membership in the Berrien Kennel Club. 
 
Signature _________________________________________________________ Date ________________________ 
 
DO NOT WRITE BELOW THIS LINE 
………………………………………………………………………………………………………………………………………………………. 
 

Date Received: _____________________________ 
 
Date Accepted: _____________________________   
Date Rejected: _______________________ 
 
Member is a: Single membership ______   
Junior membership ______ 
 
FEE PAID: $ _________________ 
 
_________________________________________________________________________________________________ 
Membership Committee Person Signature   
 
Date 

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