The Norfolk Terrier Club by 1WDs6Hn


									                       The Norfolk terrier Club
                    Associate Membership Application

Complete the appropriate sections of the application and mail, along with your dues, to the membership
chair at the address below.

Associate Member dues are $25/household/year, which includes a subscription to the Norfolk Notes (by
email), the Norfolk News and the Annual. Please include your dues with the application. Your application
will be reviewed in a timely fashion and upon acceptance, the club’s secretary will notify you. Please note
that associate members do not have voting rights.

Please check one:

___ I/We are applying for Associate Membership in the NTC. If you have a Sponsor, who must be an
NTC member, complete page1 and sign on page 2 of the application. If you do not have a sponsor,
complete both pages of the application.

___ I am a current NTC Member and am giving an Associate Membership to a new Norfolk owner.
Please complete the front page of the application and mail to the membership chair with the dues

Applicant(s) Name: ___________________________________________________________(print)

Street Address: ____________________________________________

City:   __________________________________________________

State: _____________________ Zip Code: __________________

Home Phone: _________________ Cell Phone:_________________ Work Phone:_________________

Fax Number: _________________ E-Mail: ________________________________________________

Occupation: ________________________________________________

List the names of your Sponsor, if applicable. (They must be a Norfolk Terrier Club member.)


Please list the AKC Registered name of the Norfolk (s)`you currently own/or owned as well as any co-
owners and the breeder. If you own additional Norfolk Terriers please list on separate paper and include
with application

Name of dog: _________________________________________

Owner(s);     _________________________________________

Breeder;      _________________________________________

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How many dogs other than Norfolk do you presently own: _____ breed(s): ________________________

Briefly describe how your Norfolk are housed:

Do you exhibit or plan to exhibit your Norfolk in AKC events: yes        no
If yes, circle those that are applicable:

Conformation      Agility Obedience       Rally   Earthdog `Other____________

Do you breed or plan to breed your Norfolk(s)        yes    no

Other than Norfolk have you bred another breed yes no What breed: _________________________

Have you ever been suspended by the American Kennel Club: yes no

Is there a particular area you feel you would like to be of service to the Norfolk Terrier Club?

Circle all that interest you:

Trophy      Notions      Website    Hospitality    Rescue     Health      Statistics   Advertising

Performance Events         Artist   Writer (AKC Gazette-NTC NEWS- Online News)

I/We hereby apply for Associate Membership in the Norfolk Terrier Club. If accepted I/We agree to abide
by the club’s Constitution and By Law and the rules of the American Kennel Club.

Name(s) __________________________________ ____________________________________(print)

Signature(s) ________________________________ _____________________________________


Mail completed application and dues to:

Jeff Partington
Membership Chair
9316 S. Pepperwood Lane
Highlands Ranch, CO 80126


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