Penn-Dutch Great Pyrenees Club

Application for Membership

Please answer all questions as fully as possible. The needs, interests, and experiences of our members serve as the guidelines for our activities. Please use a separate application for each family member applying.

NAME: _____________________________ DATE: __________________ ADDRESS: ______________________________________________________ HOME PHONE #: ________________ WORK PHONE #:________________ E-MAIL ADDRESS: _______________________________________________ Do you own a Great Pyrenees? Yes ___ No ___ Year lst Pyr acquired: ___________ Where did you acquire your Pyr(s)? ____________________________ # of males you currently own: __ # neutered:__ Age(s):_______ # of females you currently own: __ # spayed:__ Age(s):_______ Call names of your Pyrs: ______________________________________ Have you bred Pyrs? Yes__ No__ Do you plan to? Yes__ No__ Have you trained Pyrs? Yes__ No__ Shown Pyrs? Yes__ No__ What are your interests in Great Pyrenees?_____________________ _______________________________________________________________ _______________________________________________________________ Please list other dog clubs of which you are, or have been, a member: _______________________________________________________ I will abide by the Constitution and By-Laws of the Penn-Dutch Great Pyrenees Club and the rules and regulations of the American Kennel Club. I am not under suspension by either the American Kennel Club or the Great Pyrenees Club of America. (signature) _______________________________________ Please __FULL MEMBER- $11.00 (Active in Southeastern PA Pyrs) Check __ASSOCIATE MEMBER- $8.00 (Informational, non-voting) One: __JUNIOR ASSOCIATE MEMBER- $2.00 (10 - 16 years old) Age (of Jr. memb.): _____
Please send this application, along with your dues check in the appropriate amount made out to the Penn-Dutch Great Pyrenees Club, to: David Kintsfather, 239 E. Weiss St., Topton, PA 19562.

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