I hereby apply for membership in the Helderberg Bernese Mountain Dog Club. Download .PDF Application
Please download, sign and submit a copy of the Code of Ethics if you area applying for voting membership only.Download .PDF Code of Ethics
HELDERBERG BERNESE MOUNTAIN DOG CLUB OF NEW YORK
MEMBERSHIP APPLICATION FORM
Name: _________________________________________________________________
Address: _______________________________________________________________
Phone: __________________________ Email: ________________________________
Occupation: ____________________________________________________________
# of BMD’s owned: ____________ Other Breeds owned: ________________________
Do you currently belong to any other dog clubs? If so, which ones. _________________________
__________________________________________________________________________________
Have you ever been charged with animal cruelty? ______ Yes ______ No
Have you ever been, or are you currently suspended from the privileges of the American Kennel
Club? ______Yes ______No
If Yes, please explain: ___________________________________________________________
_______________________________________________________________________________
I am interested in: _____Conformation _____Obedience _____Tracking
_____Agility _____Therapy _____Grooming _____Carting/Drafting _____
_____ Fun _____Other (please specify): ______________________________
I would like to volunteer for the following: _____ Match _____ Rescue _____Show
_____Supported Entry _____Board Member _____Ways and Means
_____ Newsletter _____ Hospitality _____Education _____ Programs for
Meetings _____ Other (please specify) ______________________________
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ANNUAL DUES:
_______ Individual (voting) $20.00
______ Household (voting) $25.00
______ Associate $15.00
_______ Donation to the Rescue Fund (optional, but most welcomed)
_______ Donation to the General Fund (optional, but most welcomed)
________ TOTAL ENCLOSED Date: ________________
NOTE: For a voting member application you must include the names of two Club sponsors, who are in good standing and are unrelated to you. Also, you must sign the Code of Ethics and send it with this application.
Signature of Sponsor #1: __________________________________________________________
Signature of Sponsor #2: __________________________________________________________
In applying for membership in the Helderberg Bernese Mountain Dog Club of New York (HBMDCNY), I agree to comply with all The American Kennel Club rules and regulations, and the Constitution and Bylaws of the HBMDCNY.
Signature:__________________________________________ Date: __________________
Signature: _________________________________________ Date: __________________
The best way to keep you up to date about Club activities is to add you to our Club’s yahoo list.
May we add your email address to this list? _____Yes _____ No
You will be notified when your application has been approved, and you have been elected to membership into the HBMDCNY.
On behalf of the HBMDCNY, we thank you for your interest.