(note: it is necessary to copy and paste the application into a new document or the body of an email)
Please complete all questions on the form and either email it to: mayopete@msn.com or snail mail to the address at the bottom of the application.
Name:
Address:
City, State, Zip: ,
Email Address:
Interests: (Check all that apply)
( ) Obedience ( ) Tracking ( ) Field Trials
( ) Hunt Tests ( ) Agility ( ) Conformation Exhibitor
( ) Rescue ( ) Pet Owner ( ) Guiding Eyes Supporter
( ) Stud Service ( ) Puppy Referral ( ) Adult Dogs Occasionally
( ) Puppies for Sale Occasionally ( ) Public Education
( ) Other (please explain)
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
