PARSON RUSSELL TERRIER ASSOCIATION
OF AMERICA, INC.
Newsletter Application

Newsletter Membership is open to persons 18 years of age and older who wish to receive the newsletter. Newsletter members are ineligible to vote or hold office and said members shall not count in determination of a quorum.
Mail $25 fee, made payable to PRTAA, and completed application to:
Peggy Crane, PRTAA Secretary
4129 Keefer Road
Chico, CA 95973

PLEASE PRINT LEGIBLY

NAME_____________________________________________________________________________________
ADDRESS_________________________________________________________________________________
_____________________________________________________________________ZIP_________________
PHONE NUMBER_(_____)______________________EMAIL_____________________________________
OCCUPATION_______________________________________________________________________________
KENNEL NAME ______________________________________________________________________________
YOUR PRIMARY INTEREST(S) IN DOGS: SHOW________ COMPANION_________
PERFORMANCE (specify)_____________________________________________________________________
OTHER (specify)____________________________________________________________________________
BREEDS PRESENTLY OWNED: Parson Russell Terrier _____How Many________________
OTHER BREEDS________________________________________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 NAMES OF CLUBS, OFFICES & DATES HELD, AND REASON FOR LEAVING IF
NO LONGER A MEMBER:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
HAVE YOU EVER BEEN SUSENDED FROM AKC/PRTAA/JRTAA PRIVILEGES?_______
IF SO, LIST DATE AND REASON FOR SUSPENSION __________________________________________
_____________________________________________________________________________________________
ARE YOU PRESENTLY IN GOOD STANDING WITH THE AKC?_________
IF NOT, WHY? __________________________________________________________________
_____________________________________________________________________________________________
Signature:____________________________________________Date_____________________
PRTAA/SLT/11-04 (Internet version 2)    END OF FORM