New Membership Application
(List two household members if you choose a household membership as each member
has a vote. Only one member may hold office.)
Do you approve of your contact information being posted on the BRTCNJ: Web-site: Yes ( ) No ( ) Newsletter: Yes ( ) No ( )
List other All-breed or Specialty Clubs to which you now belong and offices held (if any).
Owner of how many Black Russian Terriers?____________________________________________
Co-owner of how many Black Russian Terriers?_________________________________________
If elected to membership, will you be willing to serve on a committee(s)? ( ) Yes ( ) No
Please check the Committee(s) on which you would be interested in working.
Advertising/Catalog____ Historian/Librarian______ Picnic______ Audio/Photography______ Judging Committee_______ Match Show______ Public Education______ Budget________ Publicity______Trophies_______ Sunshine______ Membership______Club Property_______ Newsletter______ Fund Raising_______Rescue________
I have read and agreed with the code of ethics Yes ( ) No ( )
If elected to membership, I hereby agree to abide by the Constitution,By -Laws and the Code of Ethics of the Black Russian Terrier Club of Northern New Jersey and the Rules and Regulations of the American Kennel Club
Signature of Applicant Date
Circle appropriate Membership
Regular Membership - Individual $25
Household Membership $50
Associate Membership $15
Overseas Membership $25 plus shipping & Handling
Your membership fees will be deposited upon the acceptance of your membership. Payment must be made in U.S. Funds.
THE FOLLOWING PORTION TO BE COMPLETED BY TWO SPONSORS
Sponsors must be BRTCNNJ members in good standing and must have been a member of BRTCNNJ for at least a minimum 3 years.
Name of Sponsor (please print) Signature of Sponsor Date
Please send Application to:
Vincent Modica 175 Stagecoach Road Cape May Court House, NJ 08210
THE FOLLOWING PORTION IS FOR CLUB USE ONLY
Application Received by Membership Chairperson_________________
Has applicant met three service requirement _________________
Is application complete with sponsorship__________________________
Read Application at Meeting _________________________________
Sent Constitution & By-laws __________________________________
Sent Acceptance Letter ______________________________________