Membership Application

Northwestern Wisconsin K-9 Club, Inc. Membership Application

DATE: ________________

NAME: ______________________________________________________________

ADDRESS: ___________________________________________________________

CITY: _____________________________STATE:__________ZIP:_______________

PHONE(S): ___________________________________________________________

E-MAIL:______________________________________________________________

AS MEMBERS OF THE NWK9C, YOUR PARTICIPATION IN THE CLUB IS IMPORTANT. PLEASE VOLUNTEER YOUR TIME BY HELPING AT CLUB EVENTS. IT TAKES ALL OF US TO RUN A CLUB.
Areas in which you wish to help the NWK-9C
(Check all that apply)
____Officer/Board member_____Teaching ___Telephone ___Secretarial____ Newsletter ____Fund raising ____Historian ___Hospitality ____Photography _____Web site
___ Youth Leader_____Equipment Maintenance ____Working at club activities

OTHER? PLEASE DESCRIBE____________________________________________
_____________________________________________________________________
WHAT ARE YOUR AREAS OF INTEREST FOR ACTIVITIES/TRAINING WITH YOUR DOG? _____________________________________________________________________
_____________________________________________________________________

NORTHWESTERN WISCONSIN K-9 CLUB Annual Dues:
REGULAR MEMBERSHIP (VOTING, CAN HOLD OFFICE)
$15/Person (1 vote), $25/Family (2 votes per address)
ASSOCIATE MEMBERSHIP, (NON-VOTING, CANNOT HOLD OFFICE)
$10/Person, $15/Family
SENIOR OR DISABLED MEMBERSHIP (VOTING, CAN HOLD OFFICE)
$5
JUNIOR MEMBERSHIP, (12 TO 17 YEARS OF AGE, NON-VOTING, CANNOT HOLD OFFICE)
$5 (THIS IS A MEMBERSHIP FOR CHILDREN WHO ARE NOT PART OF A FAMILY MEMBERSHIP

In consideration of my acceptance into membership in this club, I hereby agree not to hold the Northwestern Wisconsin K-9 Club, its Officers, Directors, Training Instructors, nor the landlord(s) of the property and building where club events are held, liable for any loss or damage that may occur to my person or property as a result of my participation in club activities. I also agree to abide by the Constitution, By-Laws and Policies of the club.

Signed: _______________________________ Date: ___________________

I am enclosing $_______________for______________________________
(type of membership)
Make check payable to: NWK9C.

Mail completed form and payment to:
Debi Mikkelson
NWK9C
PO Box 195
Siren, Wi 54872