PILGRIM DOBERMAN PINSCHER CLUB, INC.

Membership Application

I hereby apply for membership in the Pilgrim Doberman Pinscher Club, Inc., and submit this application together with a dues payment ($18.00) for the current year.  Please note: applications approved on or after October 1 of the current year will have their payment applied to dues for the coming year.

NAME: _____________________________________________________________________________________________________________________

ADDRESS: __________________________________________________________________________________________________________________

Former address, if less than 2 years at above:

____________________________________________________________________________________________________________________________

HOME TELEPHONE: (     ) ____-_______ OCCUPATION: ___________________________  E mail ADDRESS:______________________________

BUSINESS ADDRESS: ________________________________________________________________________________________________________

BUSINESS TELEPHONE: (     ) ____________________               HOW  LONG HAVE YOU OWNED A DOBERMAN? _________________

PLEASE LIST ALL AKC-REGISTERED DOBERMANS YOU PRESENTLY OWN OR CO-OWN:

               Registered Name                                                                                                                           AKC Registration Number                             Sex

_____________________________________________________________________________        ____________________________              ____

_____________________________________________________________________________        ____________________________              ____

_____________________________________________________________________________        ____________________________              ____

Please list any rescue Doberman(s) currently owned by you as well as all Dobermans previously owned by you on the

                                                          other side of this application

I AM INTERESTED IN:         ___  breed/confirmation   ___ obedience    ___ agility    ___ tracking    ___ therapy

I CURRENTLY DO:              ___  breed/confirmation   ___ obedience    ___ agility    ___ tracking    ___ therapy

           ARE YOU AN AKC-LICENSED JUDGE? ______    DO YOU HANDLE DOGS PROFESSIONALLY? ______

           DO YOU HANDLE YOUR OWN DOGS AT MATCHES? _____   AT POINT SHOWS? ______

HAVE YOU EVER BRED DOBERMANS? (   ) YES  (   ) NO     If “yes”, number of litters bred: _______

KENNEL NAME: ____________________________________________________________________  Is your kennel name registered? (   ) Yes  (  ) No

HAVE YOU EVER BEEN SUSPENDED BY THE AKC? ____ If, “yes” give details on the other side of this application

PLEASE LIST PILGRIM MEMBERS (OTHER THAN YOUR SPONSORS) THAT YOU ARE ACQUAINTED WITH:

____________________________________________________________________________________________________________________________

WHY DO YOU WANT TO JOIN PILGRIM?

____________________________________________________________________________________________________________________________

If accepted, I agree to abide by the Constitution and By-Laws of the Pilgrim Doberman Pinscher Club, Inc. and to put forth all effort toward the betterment of the Doberman Pinscher breed.

Applicant’s Signature ____________________________________________________________________   Date ________________________________

    ________________________________________________________                    _______________________________________________________

        1^st Sponsor’s Signature                                                                                                    2^nd Sponsor’s Signature