Date__________________________

Name___________________________________________________

Address_________________________________________________

________________________________________________________    Email______________________

Telephone (_____) ________________Cell Phone_________________________

Occupation ______________________________________________

Are you a member of other dog clubs? _________________________

Are you an active Boxer Breeder? Y N Number of Litters _________

Do you show your dogs in Conformation Y N Obedience Y N Agility Y N

Does your dog have CGC ( Canine Good Citizen ) Y N     TD ( Therapy Dog ) Y N

Service Dog Y N

Are you involved with a Pet Rescue Organization or do you volunteer at a Humane Society ?

Applications must be accompanied by the first years non refundable dues of $50.00 for single and $75.00 for couple.

Associate Membership dues $37.50 for family or $25.00 for single. Junior Membership dues $10.00.

You are required to have 2 sponsors along with your application

_________________________             ____________________________

signature of sponsor                                  signature of sponsor

Make check payable to: Upstate Boxer Club

Mail to our secretary:     Christina McNamara

                                          1260 Millcreek Run

                                          Webster, NY 14580

Each applicant must do a job and attend 3 meeting before the club may vote on

their membership.

How do you plan to help the Breed and the Club?   Describe briefly your interest in Boxers and your reasons for

seeking Upstate Boxer Club.

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Give  the names and addresses of several other people identified with our breed with which you are acquainted…

________________________________________________________________________________________________

________________________________________________________________________________________________

_________________________________________________________________________________________________

I hereby apply for membership in the Upstate New York  Boxer Club.  If accepted I agree to abide by the Constitution, By-Laws, rules and regulations of both the Upstate New York Boxer Club and the AKC

__________________________                    ______                                    ___________________________          ______

Applicant's signature                                            Date                                        Applicant's signature                                      Date