Date: __________________

Name: _________________________________________________________________

Phone: _____________________

Address:_________________________________________________________________________________

________________________________________________________________________________________

Business Address: _____________________________________________________________________________________

E-mail Address: _____________________________________________________________________________________

I own/have owned a Newfoundland dog: (   ) Yes (   ) No

I am an owner / partner in the _________________________________________________kennel.

I am a member of the following dog clubs: _______________________________________________________________

Member of Newfoundland Club of America (   ) Yes (   ) No

Please indicate the activities or events your are interested in:

(   ) Backpacking   (   ) Fun Matches  (   ) Search and Rescue

(   ) Breed Showing   (   ) Handling   (   ) Specialty Shows

(   ) Carting (   ) Hospitality  (   ) Therapy Dogs

(   ) Educational Seminars (   ) Obedience (   ) Water rescue

Type of Membership:

(   ) Renewal of General Membership (Individual $25, Family $30)

(   ) Newsletter Subscription ($15)

(   ) New/Associate Membership (Individual $20, Family $25)

Newsletter Subscription: Is a non-voting membership, but will receive copies of all newsletters and notification of all meetings and events. Will not be voted into General membership.

Associate Membership: Will receive newsletters and notification of all meetings and events. In order to become a General Member, attendance is required at a minimum of two (2) meetings and approval by General membership vote. General Members are entitled to vote and hold elected office. Associate membership requires sponsorship from one (1) General Member of GRNC.

Sponsor: ________________________________________________________________________________

Make Check or money order payable for Genesee Region Newfoundland Club (GRNC).

Signature of Applicant(s):  ____________________________________________________________
Applicant agrees to abide by the Constitution and By-Laws of the GRNC and the rules of the American Kennel Club (AKC).

Send application to: Ann McPhilmy, 5484 Rathbun Rd, Cazenovia, NY 13035

telephone: 315-655-5478