Date__________________________

Name___________________________________________________

Address_________________________________________________

_________________________________________________

Telephone (_____) ________________

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 dues of $50.00 for single and $75.00 for couple.

Associate Membership dues $37.50 for family or $25.oo 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: Holly Cooke

                                    1246 Holley Road

                                    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 Boxer Club, and if accepted agree to abide by it Constitution, By-Laws, rules and regulations

__________________________                    ______                                    ___________________________          ______

Applicants signature                                            Date                                        Applicants signature                                      Date