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Please print and mail to:
Central Virginia Collie Club
P.O. Box 481, Dinwiddie, Va. 23841




CENTRAL VIRGINIA COLLIE CLUB
MEMBERSHIP APPLICATION

NAME(S):_______________________________________________________________________

ADDRESS:______________________________________________________________________

CITY:___________________________STATE:_________ZIP:____________

PHONE #:______________________ EMAIL ADDRESS:_______________________________

BIRTHDATE(S): MONTH___________ DAY____________
   MONTH___________ DAY____________
 
YOUR WEBSITE URL:___________________________________

ACTIVITIES & OTHER CLUB MEMBERSHIPS:___________________________________
______________________________________________________________________________
______________________________________________________________________________

WHY DO YOU WANT TO BE A MEMBER OF THIS CLUB?_________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

HAVE YOU DONE ANY BREEDINGS, OR ARE YOU PLANNING A BREEDING PROGRAM?  YES____ NO____

IF YES, EXPLAIN:_____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

DO YOU EXHIBIT IN CONFORMATION?  YES____ NO____
DO YOU EXHIBIT IN OBEDIENCE?   YES____ NO____
DO YOU EXHIBIT IN HERDING?   YES____ NO____
DO YOU EXHIBIT IN RALLY?    YES____ NO____

DO YOU PLAN ON EXHIBITING IN CONFORMATION? YES____ NO____
DO YOU PLAN ON EXHIBITING IN OBEDIENCE?  YES____ NO____
DO YOU PLAN ON EXHIBITING IN HERDING?  YES____ NO____
DO YOU PLAN ON EXHIBITING IN RALLY?   YES____ NO____

AKC TITLES EARNED:________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

HAVE YOU EVER BEEN SUSPENDED BY AKC?  YES____ NO____
IF SO, WHY?__________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

DO YOU BELONG TO THE COLLIE CLUB OF AMERICA?    YES____    NO____

DO YOU SUBSCRIBE TO ANY COLLIE PUBLICATIONS?     YES____       NO___
PLEASE LIST:_______________________________________________________________
_____________________________________________________________________________

FOR OUR CLUB FUNCTIONS (SHOWS, MATCHES, YARD SALES, ETC.) WOULD YOU HELP WITH BAKE SALE WORK, DONATIONS, TYPING, FUND RAISING, PUBLICITY, STEWARDING, PHOTOGRAPHY, OTHER?
PLEASE LIST:__________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

ON WHAT SUBJECTS WOULD YOU LIKE TO SEE PROGRAMS?_______________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

ALL MEMBERS ARE REQUESTED TO SERVE ON A COMMITTEE.  PLEASE INDICATE YOUR PREFERENCES.
MEMBERSHIP    YES____ NO____
PUBLICITY    YES____ NO____
WAYS & MEANS   YES____ NO____
AUDIT     YES____ NO____
HOSPITALITY    YES____ NO____
FINANCE    YES____ NO____
FEDERATION DELEGATE  YES____ NO____
FEDERATION ALTERNATE  YES____ NO____
SUNSHINE    YES____ NO____
TROPHIES/GIFTS   YES____ NO____
PROGRAMS    YES____ NO____
SHOWS/MATCHES   YES____ NO____

****PLEASE READ CAREFULLY****

MEMBERSHIP DUES ARE PAYABLE UPON APPLICATION.  FEES ARE AS FOLLOWS:
INDIVIDUAL MEMBERSHIP-$20.00; JOINT MEMBERSHIP (COUPLE)-$25.00; JUNIOR MEMBERSHIP-$5.00; ASSOCIATE MEMBERSHIP (INDIVIDUAL)-$15.00; ASSOCIATE MEMBERSHIP (COUPLE)-$20.00-(ASSOCIATE MEMBERS ARE UNABLE TO VOTE IN CLUB MATTERS).  ***ALL MEMBERSHIP TYPES, REQUIRE A ONE TIME INITIATION FEE OF $10.00 PER ADULTS AND $5.00 PER JUNIOR MEMBERS.
APPLICATION MUST BE SIGNED BY TWO SPONSORS (PRESENT CVCC MEMBER) AND ACCOMPANIED BY A LETTER OF RECOMMENDATION FROM EACH SPONSOR.  ASSOCIATE MEMBERSHIPS DO NOT REQUIRE SPONSORSHIP LETTERS.  THE BOARD OF DIRECTORS WILL REVIEW THESE APPLICATIONS.  APPLICANT UNDERSTANDS THAT ACCEPTANCE OF APPLICATIONS/DUES BY THE CLUB IS CONDITIONAL AND THAT IF THE APPLICATION IS NOT APPROVED, THE APPLICANT WILL RECEIVE A FULL REFUND.

I AGREE TO ABIDE BY THE CVCC CONSTITUTION, BYLAWS, STANDING RULES, AND THE RULES OF THE AMERICAN KENNEL CLUB:

TYPE OF MEMBERSHIP?____________________________________________________

SIGNATURE:_______________________________________________________________

DATE:___________________________________

SPONSOR SIGNATURE:____________________________________________________

SPONSOR SIGNATURE:____________________________________________________

APPROVED BY: BOARD YES____ NO____  DATE____________
   MEMBERSHIP YES____ NO____  DATE____________

REV. FEB. 2005