Application for Membership

Annual Fees due January 1st

Single membership $15.00

Family/Same House-hold membership   $25.00

Name:  __________________________________________________________

Address:  ________________________________________________________

City: __________________________________State: _______Zip:  __________

Phone: (       )__________________Email Address: _______________________

Occupation: __________________________Date of birth: _________________

Sponsors signature: ________________________________________________

Action taken by Board: __________________Membership: _________________

Please answer the following questions.

Why did you choose a Boston Terrier, or how did you get interested in the breed? ____________

_____________________________________________________________________________ _____________________________________________________________________________

Have you bred your Boston Terrier? _________ If so, how many litters have you had? ________

Do you belong to other dog clubs, if so list them?______________________________________

_____________________________________________________________________________

Do you show in conformation, trial in agility or obedience, or just enjoy Boston Terriers? _____

_____________________________________________________________________________

What are the reasons for wishing to join the club? _____________________________________

_____________________________________________________________________________ _____________________________________________________________________________

Are you willing to participate in club functions, such as (check those that apply)

Working and assisting at shows: _____

Fund raising: _____

Attending meetings: _____

Public education activities: _____

Rescue work: _____

 Revised January 2007