Membership Application Form

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Schedule of fees:

First Applicant (Canadian Resident)...............................$20.00

First Applicant (non-resident)...........................................$25.00

Each additional family member (non-voting)...................$ 5.00

Application fee (non-refundable).......................................$ 5.00

Note: Club Year runs from September 1st to August 31st. If joining between September 1st and May 31st, the full fee for the balance of that year applies. If joining between June 1st and August 31st you may pay a $5.00 fee to cover the balance of the current Club Year and then your $20.00 fee will cover the next Club Year.

Between June 1st and August 31st add............................$ 5.00

Total enclosed.................................................................................................................... $___________________

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Please print clearly:

Name:________________________________________ Phone #:_____________________________

Address:______________________________________________ City:_________________________

Province:____________________________________ Postal Code:____________________________

Are you a member of the Canadian Kennel Club?___________ C.K.C. #:_________________________

Name of additional family member (if applicable):___________________________________________

Number of Silkys owned:_________________

Interests (tick as many as apply):

Pet [ ] Show [ ] Obedience [ ] Flyball [ ] Agility [ ] Pet Therapy [ ] Visitation [ ]

If Canadian, and applying for Ordinary Membership, a Club Sponsor is required:

Name of Sponsor:_____________________________ Sponsor's signature:______________________

I hereby certify that I have read and understand, the Code of Ethics of the Maple Leaf Silky Terrier Club and agree to abide by same. I understand that the depositing of my cheque does not imply acceptance of my application and that should my application be refused for any reason I will be issued a refund from the club - less my $5.00 application fee.

Signature of applicant:____________________________________ Date:_______________________

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Please print out this application formand remit it, together with all appropriate fees, to:

Heather Somers, Secretary. 561 Birch Street, Campbell River, B.C. V9W 2S9 Canada.