Black Russian Terrier Club of Northern New Jersey

New Jersey Regional Club

Memebership Form

 

Black Russian Terrier Club of Northern New Jersey

 


New Membership Application

NAME_____________________________________________DATE______________________
NAME_______________________________________________________________________
(List two household members if you choose a household membership as each member
has a vote. Only one member may hold office.)
ADDRESS________________________________________City_________________________
STATE/COUNTRY/ZIP CODE______________________________________________________
PHONE___________________________________FAX_________________________________
E-MAIL______________________________________________________________________
Kennel Name_________________________________________________________________
 
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 _________________________________
Voted on_____________________________________________________

Sent Constitution & By-laws __________________________________

Sent Acceptance Letter ______________________________________
Dues paid____________________________________________________