- Labrador Retriever Club of the Piedmont
Application
Please complete all questions on the form and email it to: mayopete@msn.com

Name:
Address:
City, State, Zip: ,
Email Address:

Interests: (Check all that apply) 

(  ) Obedience (  ) Tracking (  ) Field Trials

(  ) Hunt Tests (  ) Breeding (  ) Confirmation Exhibitor 

(  ) Rescue (  ) Pet Owner (  ) Guiding Eyes Supporter 

(  ) Stud Service (  ) Puppy Referral (  ) Adult Dogs for Sale 

(  ) Puppies for Sale Occasionally  (  ) UKC

Number of dogs owned:
Number of Labrador Retrievers owned:
Names of all dogs owned:

I wish to become a member of the Labrador Retriever Club of the Piedmont and agree to abide by the Constitution and By-laws of said organization.

By typing the date and your full name you are signing this form digitally. Digital signatures are recognized under Federal Law and are acceptable for contracts.

Dated signed: Full Name for signature:

I have been recommended by who is a member in good standing of the Labrador Retriever Club of the Piedmont.

Family Membership $25.00 Single Membership $15.00

Make Checks to: Lab Club of the Piedmont

Mail to :

LRCPiedmont, Secretary (Membership Application)

3653 Highway 601 N.

Mocksville NC 27018
Otter Tails

"Otter Tails" is the official Newsletter of LRC Piedmont.  

Current Edition - April, 2006

Please send all newsletter submissions to Helen Gipe at hgipe15593@aol.com