Heartland Boston Terrier Club

Application for Membership

Type of Membership:

Single (Dues: $10 per year)                        Couples (Dues: $15 per year)

Please provide the following contact information:

* Name
Spouse Name
* Street Address
* City
* State
* Zip Code
* Home Phone Work Phone
* E-mail FAX
Occupation: Mr. Mrs.

Interest (Check all that apply)

Breeder                 Exhibitor/Conformation  Exhibitor/Obedience     Fancier/Pet Ownership 
Club Participation      Other

I wish to receive meeting notices and club communication by:

E-Mail     U.S. Mail

* Recommended by:                                                                            * Date:          

                                        -- mm/dd/yy  
                  Regular Member

* Recommended by:                                                                            * Date:

                                        -- mm/dd/yy
                  Regular Member

   Recommended by:                                                                              Date:

                                        -- mm/dd/yy

 

* What is your history with the breed?

 

* - denotes a required field


Along with your dues, please print out and sign a copy of our Code of Ethics.

Please send payment for dues to:                    Peggy O'Brien, Secretary

                                                                              802 South Oakland

                                                                              Harrisonville, MO. 64701

 

No information that you provide is stored on this web server.  All information is e-mailed to the Club Secretary for record keeping and contact information only. - webmaster


Board Approved
Copyright © 2005 Heartland Boston Terrier Club. All rights reserved.
Revised: May 25, 2007