Membership Application Illiana Japanese Chin Club

Name: _ Kennel Name:___

Address:___________________________________________________________________

Phone:__________________________ Email:_____________________________________

Individual Membership $10_________________ Junior $5 (under 18) _________________

Do you own one or more Japanese Chin?	Yes	No
Are your Japanese Chin AKC Registered?	Yes	No
Are you a member in Good Standing with the AKC?	Yes	No
Are you a member of any other dog club, single or All-Breed?	Yes	No
Do you or have you held office in any other club?	Yes	No
Do you breed Chin?	Yes	No
Do you exhibit Chin?	Yes	No
Do you breed or exhibit other breeds? If yes, what?	Yes	No
Are you a professional in any of the following:
Judging?	Yes	No
Handling?	Yes	No
Grooming?	Yes	No
Training?	Yes	No
Veterinary Medical Services?	Yes	No
Indicate your areas of interest:
Confirmation	Yes	No
Obedience	Yes	No
Performance Events	Yes	No
Breeding	Yes	No
Will you be willing to serve on a committee?	Yes	No

I, the undersigned, apply for membership of the Illiana Japanese Chin Club.
I agree to abide by the Constitution & Bylaws of this Club & the rules & regulations of the American Kennel Club
I agree to always work for the advancement of the Japanese Chin Fancy.
I have read and answered all questions on this application truthfully.
I understand that any misrepresentations will be cause for immediate suspension or dismissal from the Club.

Signed:_____________________________________________Date:__________________

Mail to: Jacquee Gonsowski, Treasurer IJCC, 129 North Ahrens, Lombard, IL. 60148

Name: ___________________________ Kennel Name:_____________________________

Name: _ Kennel Name:___