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PARSON RUSSELL TERRIER ASSOCIATION
OF AMERICA, INC. |
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PLEASE PRINT LEGIBLY
MEMBERSHIP FEE: Single (must be aged 18 or over) ($25.00) ____ Household ($40.00) ____| NAME(S)__________________________________________________________________________________ |
| ADDRESS__________________________________________________________________ ZIP____________ |
| PHONE_(_____)_______________ EMAIL _______________________OCCUPATION___________________ |
| YOUR PRIMARY INTEREST IN DOGS: SHOW_________COMPANION_________ |
| PERFORMANCE (specify)_____________________________________________________________ |
| OTHER (specify)_________________________________________ |
| BREEDS PRESENTLY OWNED: Parson Russell Terrier_____________How Many__________________ |
| Other Breeds (Specify Breed(s) and How Many)______________________________ |
| HAVE YOU BRED ANY PARSON RUSSELL LITTERS?____________HOW MANY________________ |
| OTHER BREED(s)? (Specify Breed and How Many)________________________ |
| DO YOU BELONG TO OR HAVE YOU BELONGED TO ANY OTHER KENNEL OR SPECIALTY CLUBS?____ |
| IF SO, LIST NAME(S) OF CLUBS, OFFICES HELD & DATES, AND REASON FOR LEAVING IF NO LONGER |
| A MEMBER:_______________________________________________________________________________ |
| __________________________________________________________________________________________ |
| HAVE YOU EVER BEEN SUSPENDED FROM AKC/PRTAA/JRTAA PRIVILEGES?___________________ |
| IF SO, WHY?(LIST DATE AND REASON FOR SUSPENSION)_______________________________________ |
| __________________________________________________________________________________________ |
| ARE YOU PRESENTLY IN GOOD STANDING WITH THE AKC/PRTAA?____________________ |
| IF NOT, WHY?_____________________________________________________________________________ |
| __________________________________________________________________________________________ |
IF GRANTED MEMBERSHIP IN THE PARSON RUSSELL TERRIER ASSOCIATION OF AMERICA, I (WE) AGREE TO:
I understand that failure to comply with these rules will result in my suspension and possible expulsion. Any false information or omission with the intent to deceive the PRTAA or its membership will result in an invalidation of membership and/or a withdrawal of application.
| SIGNATURE : Applicant(s) |
_________________________________________Date______________ _________________________________________Date______________ |
PRTAA/SLT/11-04 (Internet version 1) END OF PAGE 1 SEE PAGE 2