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Membership Application
Membership Application
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
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?
Choose Option
yes
no
If so, when?
Reason?
Are you a breeder?
Choose Option
yes
no
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 on the website 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 15 days after publication date to object. If there are no objections and once dues have been paid, 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
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June 15, 2013
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Wheaten Health Day
September 14, 2013
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St. Pete
Annual Dinner
November 9, 2013
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