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.): _____

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