DATE:___________________
NAME(S)____________________________________________________________
HOME PHONE______________________ CEL PHONE_______________________
ADDRESS______________________________________________________________
CITY________________________
STATE_____________________________ZIP________________________________
EMAIL_________________________
WEBSITE____________________________________________________________________
OCCUPATION(S)____________________________________________________________
_____________________________________________________________________________
1. How many dogs do you own_________?
How many Siberians?_________
AKC registered Y/N ?
Other breeds (Please specify)____________________________________________
How long have you owned Siberian Huskies?__________________________
2. What is your interest with your dog(s)? Circle all that apply: SHOW, PET, OBEDIENCE, PLEASE DOG TEAM, RACING, OTHER (describe)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3. If at any time you have been involved in showing, racing, or training your dog(s), please describe briefly show records, obedience titles, racing placements, etc.:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
4. Do you breed your dog(s)Y/N ?
If yes, how many litters have you had in the last three years?_________
How many Siberian litters?__________ ?
AKC registered Y/N ?
Kennel Name________________________________________________________
5. Has your breeding stock been X-rayed for Hip Dysplasia Y/N ? Examined by a veterinary ophthalmologist for hereditary eye diseases Y/N? If not please describe:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
6. If you have bred any litters during the past three years, please indicate the method of placement (circle all that apply): KEPT, SOLD TO PRIVATE PARTIES, SOLD TO WHOLESALE OR TO PET STORE, OTHER (describe):
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
7. Have you provided stud service during the past three years Y/N ? If yes, what requirements do you have regarding the bitch you accept for service?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
8. Have you been a member of any dog-related clubs (all-breed, obedience, Siberian Husky, sled dog, or other breed clubs) Y/N? If yes, please describe:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
9. What responsibilities did you have?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
10. Are you familiar with the standard for the Siberian Husky Y/N? Are you currently in good standing with the AKC Y/N ? Have you ever been suspended from the privileges of the AKC Y/N ? If yes, please list dates and circumstances:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
11. What do you hope to gain from membership in the Siberian Husky Club Of The Redwoods?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Submit this form together with a signed copy of the Siberian Husky Club Of The Redwoods Code of Ethics, and the Annual dues of $20.00 to the Secretary. Please make check or money order out to SHCR.
*** I/We apply for ACTIVE_____________ASSOCIATE______________ Membership
Please mark which status applies: SINGLE_________ FAMILY_________
*** I/We have read and agree to the Siberian Husky Club Of The Redwoods Constitution and By-Laws, and Code of Ethics
SIGNED _______________________________________________________________
(Applicant/s)
DATE_____________________________
ENDORSERS:
1. NAME______________________________________________PHONE_________________
ADDRESS______________________________________________CITY___________________STATE_______ZIP_________
SIGNED___________________________________________________________________DATE______________________
2. NAME______________________________________________PHONE_________________
ADDRESS______________________________________________CITY___________________STATE_______ZIP_________
SIGNED___________________________________________________________________DATE_______________________
FOR BOARD OF DIRECTORS USE
Dues remitted $_____________ Date of applicant publication______________________
Objection/s received Y/N? If yes, written objection/s must be attached to application, along with the appraisal and recommendation of the Board of Directors.
ACTION: Approved Y/N? Date of approval________________ Date of denial________________
SIGNED ___________________________________________________________
President
DATE__________________
SIGNED____________________________________________________________
Secretary
DATE__________________
Send completed form to:
SHCR Secretary
c/o Diane Willett
121 San Felipe Way
Novato, CA 94945-1611