Chesapeake Mastiff Club Membership Form

Membership is open to all reputable persons eighteen years old or older, in good standing with the American Kennel Club, and who subscribe to the rules and purposes of the club. 

Name:_________________________________________________________

Address:_______________________________________________________

_______________________________________________________________

Telephone:__________________________Fax________________________

Email:________________________________________________________

Kennel Name:__________________________________________________

Have you ever applied before?  Yes/No     If Yes, when?_______________

Single membership 25.00 per year, Family membership 35.00 per year
Mail to: Dianne White, Treasurer
	     24729 Horseshoe Rd
                 Clements, Md 20624
Make checks payable to: Chesapeake Mastiff Club
	
I agree to abide by the Code of Ethics, rules, Bylaws, and Constitution of the Chesapeake Mastiff Club. 

Signature:_______________________________________________

Date:___________________________________________________

Sponser Signature:_______________________________________

Print Name:_____________________________________________

Sponser Signature:_______________________________________

Print Name:_____________________________________________