Membership Application

Kooikerhondje Club Membership Application

Memberships are valid for the club's official year - January 1st thru December 31st.

New Members: Priviledges and rights as a member commence from date of accpetance by vote of Board of Directors.New members over the age of 18 years o age are accepted as Associate Members with no voting privileges for 6 months from the date the are recorded as an Associate Member on the Club.  Anyone joining the Club between October 1st and December 31st shall not have to pay additional dues for the ensuing year.

Renewing Members:  Dues are due on January 1st.  A membership will be considered as lapsed and automatically terminated if dues remain unpaid 90 days after the due date.  A lapsed membership renewal wll put a member's status back to Associate Member status with no voting privileges for 6 months from the date of acceptance by vote of the Board of Directors. 

Note:  If changing from single to Household status - added member will be under Associate Member status for 6 months from the date of acceptance by vote of the Board of Directors.

Membership includes the club newsletter and a membership roster in electronic PDF format.

___ Some or all of my address information is new    Note: All incomplete forms will be returned * Please print clearly!

Name:__________________________________   Occupation:___________________________

Name:__________________________________  Occupation:____________________________

Address:_____________________________________________________

City: ______________________ State:_______________ Zip: ________ Country:__________

Home #___________________________  Fax #__________________________

Email:____________________________ Other___________________________

This form cannot be processed without the appropriate valid signature(s).  Please don't forget to sign the back of this form

Please list both the registered name and the call name of your Kooiker(s), and any titles this dog may have.

Rigistered name:__________________________________________Call name:______________________

Registered name:__________________________________________Call name:______________________

Registered name:__________________________________________Call name:______________________

If you have more than three Kooikers, please continue listing them on an additional sheet.

_____Single Memberships are $10.00 (1 vote) for US residents over 18

_____Household Membershipa are $20.00 (2 votes) fr US residents over 18

_____Junior Memberships are $5.00 no votes {over 9 years and under 18 years} US residents

Roster Request:

______No roster

______Electronically - no charge

______Hard Copy  - $3.00

CANADIAN RESIDENTS PLEASE ADD $1.OO S/H.  ALL OTHER NON US COUNTRIES ADD $6.00

i have included additional funds to be used in the following Club programs:  Health & Genetices __________

                                                                                                                                                      Rescue ___________________

Are you interested in becoming active in the Club?  ______Yes   ______No  ________Currently Active

If yes, which areas are you interested in participating in: _____ Rescue  ______Public Education

Check below all activities you are now or have been involved with within the past 2 years with any breed:

___conformation ___obedience ____rally____hunting____hunting retriever tests____field trials____agility

___tracking ___flyball ____therapy ____ other _________________________________