Dues:  Single-$20.00; Family-$25.00

Other Family Members:___________________________________________________________

Address: _____________________________________________________________________

       City                                                State                        Zip Code

Phone: Home: (____)______________________;  Cell: (_____)__________________________

Email Address: _______________________________________________________________

How would you like the Topeka Kennel Club Barker Newsletter sent to you?   
(Circle One)   Mail    or     Email  

Breed(s) of Dogs Presently Owned:_____________________________________________

Past Breed(s) Owned:_________________________________________________________

The Topeka Kennel Club holds two licensed dog shows and a sanctioned match each year.   Are you willing to work at
these events?  (Circle One)     Yes   or    No

Would you be interested in serving on a Topeka Kennel Club Committee?
(Circle One)  Yes  or   No

Are you currently a member of any other Dog Club?  (Circle One)   Yes     or    No

Name of Club: ____________________________________________________

Past Memberships?  (Please list): _______________________________________


How long have you been active in dogs? __________________________________

Areas of Interest: (Check all that apply)
Breeder: ______________________                        Obedience: ________________
Conformation: _________________                        Tracking: _________________
Pet: __________________________                        Other: ____________________

Other Interests Outside of Dogs:
Hobbies: ___________________________________________________________

Sports: ____________________________________________________________

Other: _____________________________________________________________

Why do you wish to join the Topeka Kennel Club?

The Undersigned agrees to abide by the Constitution and ByLaws of the Topeka Kennel Club, Inc. and by the rules and
regulations of the American Kennel Club governing dog shows and obedience trials.

Signature of Applicant(s): ___________________________________________

Date of Application: _______________________________

*Sponsor: _______________________  *Sponsor: _________________________
* A husband and wife are considered as one membership and can serve as one sponsor.

For Club Use Only:
Date of First Reading: ________________________________   Date Dues Paid: _____________
Date of Second Reading: ______________________________  Date Voted On: _____________
Votes: YES ________________   NO ___________________