Israel Canaan Dog Club of America,
Inc.
Membership Application
Type of Application: ________ Single (1 vote) _________ Family (1 household, 2 votes, 1 newsletter)
Member’s name: _________________________________________
Occupation: __________________________________________
Address: ___________________________________________________________________
City: ________________________ State: _____ Zip:________ Country: ________________
Home Phone: _________________________
Other phone numbers (mobile, fax, work, etc): _____________________________________________
Email: ______________________________________________ (Membership renewals and infrequent notices will be emailed when possible to reduce club expenses.)
If family membership, 2nd Adult’s name: _____________________________________
Occupation: ________________________ Email: ____________________________________
Children’s names: ______________________________________________
Kennel Name (if any): ______________________________________________________
How did you hear about the breed? ______________________________________________________
How did you hear about the club? ______________________________________________________
Average number of dogs you have: ______ Breeds: _______________________________
If you have a Canaan: When did you acquire your first?___________ How many do you have? _________
If you do not have a Canaan: Do you plan to get one in the next year? ____________
If so, what breeder, if any, have you selected? ______________________________________
List all dog related clubs to which you have belonged or do belong, dates of membership and positions held:
______________________________________________________________________________________
______________________________________________________________________________________
In what sports/activities do you and your dog(s) currently participate? (please circle)
Pet Breeding Conformation Obedience Agility Herding Tracking Other:_______
Areas of future interest: (please circle)
Pet Breeding Conformation Obedience Agility Herding Tracking Other:_______
List all Canaans you have had in the last 5 years (please use additional page if more space is needed).
Call name: ___________________________ Call name: ___________________________
DOB: _______________________________ DOB: _______________________________
Breeder: _____________________________ Breeder: _____________________________
Registered name: ______________________ Registered name: ______________________
All titles earned: _______________________ All titles earned: _______________________
Registries: ____________________________ Registries: ____________________________
Male or Female: _______________________ Male or Female: _______________________
Intact or Neutered: _____________________ Intact or Neutered: _____________________
Number of litters sired or whelped: ________ Number of litters sired or whelped: ________
If you have been a breeder during the last 5 years, list the breed and numbers of litters of each breed you have whelped other than the Canaans listed above:
______________________________________________________________________________________
List championships or titles that you have completed other than the Canaans listed above:
______________________________________________________________________________________
The ICDCA is an all volunteer organization. Please circle the areas in which you can help.
* desktop publishing , e.g., producing a newsletter, premium list, catalog, other club's publication projects
* other computer skills, e.g., databases, web pages, etc
* art, crafts, photography, photo editing, movie production (videotape of course)
* writing, e.g., contributing articles, brochures, posting on bulletin boards, etc
* people skills, e.g., contacts with members, with the general public
* PR skills, e.g., enhancing the visibility of the Club in the dog world
* professional skills, e.g., knowledge of law, veterinary, genetics, accounting, other __________
* dog show experience, e.g., specialty tasks: show secretary, steward, trophies, hospitality, etc
* other skills _________________________________________
Please explain why you wish to be a member of the ICDCA:
______________________________________________________________________________________
______________________________________________________________________________________
I agree to abide by the
Constitution, By-Laws, and the Code of Ethics of the ICDCA and by the rules
and regulations of the United Kennel Club. I
understand that until my application is approved, I will be a Provisional
Member of the ICDCA with all the membership privileges but without the right
to vote. In case my application were not approved, the ICDCA is not be obligated
to make the reasons known to me and my Provisional Membership will be converted
to a newsletter subscription.
Signature(s): ________________________________ Date: _____________
________________________________ Date: _____________