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WEST TENNESSEE
HUNTING RETRIEVER CLUB*

MEMBERSHIP APPLICATION
 

Name:___________________________________________________________________________________
Address:________________________________________________________________________________
City:________________________________ State:______________ Zip Code:____________________
Telephone - (H)____________________ (W)____________________ (FAX)_______________________
Dog Name:_____________________________________ UKC #______________ D.O.B._______________
Dog Name:_____________________________________ UKC #______________ D.O.B._______________
Dog Name:_____________________________________ UKC #______________ D.O.B._______________
Membership type desired (check one):  
___Individual ($20 annual fee)   ___Family ($25 annual fee)
If family membership, please list names below:
______________________________________ Relationship:____________________________________
______________________________________ Relationship:____________________________________
______________________________________ Relationship:____________________________________
Are you a member of any other retriever club(s)?   ___Yes   ___No
Retriever Club(s) names and addresses:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
 
_______________________________________		___________________________
Signature of Applicant 				Date

 
 
*West Tennessee Hunting Retriever Club is an affiliate of the UNITED KENNEL CLUB