West Highland White Terrier Club Of Northern Illinois
APPLICATION FOR MEMBERSHIP

Name:____________________________________________________________________________________

Address:__________________________________________________________________________________

City, State, Zip:_______________________________________________________________________

Phone number w/area code:________________________ Occupation: ______________________________

Email:______________________________________________________________________________

Attach a letter stating why you want to join the West Highland White Terrier Club of Northern Illinois. Tell us about your dogs (breeds owned, AKC titles in conformation, obedience, agility or other performance events) and other canine related interest.

1. My interest is as: (check one or more)

          __Pet Owner    __Breeder    __Conformation    __Obedience    __Agility    __Earthdog    __Tracking

2. a).  How many Westies do you own or co-own? _______     Other Breeds Owned: ____________________

3. Have your privileges with the AKC ever been suspended? __yes __no

          If yes, please explain __________________________________________________________________

          ____________________________________________________________________________________

4. Are you a member of any other breed, obedience or kennel club? __yes __no

          If yes, please list______________________________________________________________________

5. If approved for membership, will you be willing to participate in the work of the club such as holding office, committees or Westie rescue? __yes __no

6. Have you read the Code of Ethics (Click Here)? __yes __no

I agree to abide by the Constitution, By-laws and the Code of Ethics of the West Highland White Terrier Club of Northern Illinois, Inc., and the rules of the American Kennel Club.

SIGNATURE OF APPLICANT____________________________________________________________

SIGNATURE OF SPONSOR______________________________________________________________

SIGNATURE OF SPONSOR______________________________________________________________

Annual dues are $15.00 per person or $20.00 for two persons living in the same household.  Initiation fee of $5.00 per person. You will be billed once the application is accepted.

Have your sponsor send your application and letter to Membership Chairman, 
Tyrone Kalogeresis,  1222 W. Elmhurst St ., Bensenville , IL   60106

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date received:  _______________________     date accepted:  _________________________