AMERICAN CHESAPEAKE CLUB — MEMBERSHIP
APPLICATION
NAME
___________________________________
OCCUPATION
_________________________________
SECOND NAME FOR
FAMILY MEMBERSHIP ______________________________________________________
ADDRESS
________________________________________________________________________________
CITY
_________________________________________ STATE
_____________ ZIP _________________
TELEPHONE
__________________________ E-MAIL ADDRESS
___________________________________
ENDORSEMENT
OF TWO MEMBERS REQUIRED: (original
signatures only)
Print or
Type Names:
(1)________________________________________
(2)________________________________________
Signatures:
(1)________________________________________
(2)________________________________________
CLASS OF
MEMBERSHIP AVAILABLE AND SCHEDULE OF DUES:
Please
check the class of membership for which you are applying below. There is a
five ($5.00) initiation fee for the first year only dues.
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( )
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Individual Membership- Dues $30.00 (Open to all persons 18
or older. Enjoy all membership privileges.)
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( )
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Household Membership- Dues are $45.00 per year.(Open to all
husbands, wives, and children residing in the same household. Household
memberships offer two votes but one copy of Bulletin & yearly
directory. You MUST include the name of both people applying under a
household membership. Children under 18 are not eligible to hold office.)
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( )
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Junior Membership- Dues $20.00 per year. (Open to all
persons under 18. Enjoy all privileges except right to vote and hold
office.)
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Make checks
payable to American Chesapeake Club. Non-US members: please pay dues in US
funds drawn on US Banks only. To cover postage, international rates are an
additional $10.00 for Canadian members; $15.00 for overseas members.
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Membership Dues
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$________
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MAIL TO:
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Joanne
Silver
412 Woodbury Drive
Wyckoff, NJ 07481-1514
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How did
you hear about the ACC?
[ ]
ACC Advertising
[ ] Dog World
[ ] Gun Dog
[ ] AKC Breed
Referral
[ ] Other (Please specify)
___________________________
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Initiation Fee
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$ 5.00
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Overseas Mail
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$ 15.00
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Total Enclosed
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$________
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The
Undersigned agrees to abide by the Constitution and By-Laws of the American
Chesapeake Club and the rules of the American Kennel Club.
X _______________________________________ X
_________________________________________
(signed) (signed)
The
American Chesapeake club does have a code of Ethics that all members agree
to abide by. You will receive a copy fo the code
in your membership packet.
CLUB SUPPLIES
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PLEASE
SEND ME:
_____
American Chesapeake Club Notecards 10 pk @ 5.95 ea.
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American Chesapeake Club Pins @ $10.00 ea.
_____
American Chesapeake Club Patches @ $2.00 ea.
_____
American Chesapeake Club Decals @ $2.00 ea.
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American Chesapeake
Club Brochures @ $3.50 per dz.
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American Chesapeake Club Buckles @ $15.00 ea.
_____
American Chesapeake Club Retriever Training manual @ $5.95 ea. (overseas
$10.00)
_____American
Chesapeake Club Visors & hats @ $ 8.00 ea.
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ALL
PRICES INCLUDE MAILING COSTS
MAKE
CHECK OR MONEY ORDER PAYBLE TO AMERICAN CHESAPEAKE CLUB
MAIL
ORDER TO:
Stephanie
Adelman
10980 Little Avenue
Cologne, MN 55322
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NAME ___________________________________________________________________________
ADDRESS________________________________________________________________________
CITY____________________________ STATE______________ ZIP_________________________
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