Membership Application

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Please complete the form below and click on 'submit'. Please read the Code of Ethics found in the Breeder section of this website. Your signature on the Membership Application indicates your agreement with this Code of Ethics.

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Name

Co-applicant (if applicable)

Address

City

State

State :: Enter state initials only.

Zip Code

Zip Code :: Five digit number only

Main Phone

Main Phone :: Include area code. No dashes, no spaces.

Alternate Phone

Alternate Phone :: Include area code. No dashes, no spaces.

Email Address

Occupation

Other Club Affiliations

Have you ever been suspended by the AKC?

If so, when?

Reason?

Are you a breeder?

If so, how many litters do you produce annually?

How do you sell puppies?

Please give a brief statement why you want to become a member of SCWTCGTB. What do you expect to get fromt he club, and what can you bring to the club?

Statement

I agree to comply with the constitution and By-Laws of the Soft Coated Wheaten Terrier Club of Greater Tampa Bay and the Rules of the AKC and agree to the Code of Ethics. "Publication of prospective members in the Club newsletter shall be accompanied by an opportunity for current members to provide written comment to the Membership Chairperson should he/she have any objections to a membership application. Members shall have 30 days after publication date to object. If there are no objections, the applicant is welcomed as a Club Member. If the Membership Chairperson receives an objections, the Board will reconsider the application at the next scheduled Board meeting."

Type your name to indicate your signature

Co-Applicant, type your name to indicate your signature

Sponsor's name (if applicable)

Enter the code on the right