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Date ______________
Name ____________________________________ Occupation __________________
Street Address __________________________________________________________
City _______________________________________ State ________ ZIP _________
Home Phone __________________________ Work Phone ______________________
Email ___________________________________________
Spouse's Name ___________________________________
Do you own a pointing dog? _____________ (Yes / No)
If so, what breed? ______________________________________________
Are you interested in field trialing? ____________ (Yes / No)
Do you hunt? _____________ (Yes / No)
If so, what types of game? ________________________________________
Recommended for membership by __________________________________
Use the back of this sheet to briefly describe why you would like to become a member of this club. Please discuss
anything that you feel would help the Membership Committee evaluate your application. Items of discussion should
include your personal interests and hobbies.
Thank you for your application. A member of the Membership Committee will be in contact with you within the next
few weeks. If your application is approved, you will be expected to pay a total of $340.00 at your first club meeting.
This amount includes the following:
Membership Fee $200.00
1st Year's Dues 100.00
Key Deposit 40.00
Total $340.00
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