Irish Terrier Club of New York Membership Application

Applicant Information:

Name(s):

Address:

Town/City

State/province

Zip/Postal Code

Country

Email Address

Phone Number

From whom did you obtain your Irish Terrier?

Who is your ITCNY membership sponsor?

Please ask you sponsor to confirm support for your membership to Christine Accurso at terrier509@yahoo.com

What is your primary reason for applying for membership in ITCNY?

Are you now or have you in the past been active in other organizations whose goals pertain to dogs:

Yes No

If yes please describe:

Are you a breeder

Yes No

What is your kennel name:

Summary of Dog Ownership:

Breed Owned:

How Many:

Litters in past 2 years:

Breeding Plans

Yes No

Do you participate in or plan to participate in:

Conformation

Obedience

Agility

Rally

Breed Owned:

How Many:

Litters in past 2 years:

Breeding Plans

Yes No

Do you participate in or plan to participate in:

Conformation

Obedience

Agility

Rally

Breed Owned:

How Many:

Litters in past 2 years:

Breeding Plans

Yes No

Do you participate in or plan to participate in:

Conformation

Obedience

Agility

Rally

I have read and hereby agree to abide by the Constitution and By-Laws of the Irish Terrier Club of New York and of the American Kennel Club.

Applicant Signature:

Co-Applicant Signature:

____________________________________________

____________________________________________

Date: _____________________

Date: _____________________

Applicant(s) should print and submit this form with a check payable to The Irish Terrier Club of New York for a one-time application fee of $10, plus the annual dues of $15 per person or $25 for a household membership. Please send to Christine Accurso; Membership Secretary,ITCNY; 3330 Eugene's Road, Cutchogue, NY 11935-4334. Contact Christine with questions at terrier509@yahoo.com

Irish Terrier Club
- of -
New York

Established in 1957

Irish Terrier Club of New York Membership Application