Salt Lake Doberman Pinscher Club, Inc.
                          Application For Active Membership

Name(s): ___________________________________________ Email: __________________
Address: __________________________________ Phone: __________________________
City/State/Zip: _______________________________________________________________
Preferred Mailing Address if different from above: ___________________________________
Occupation: ________________________________ DPCA Member? __________________
Are you a member of other dog clubs? __________________________________________
Are you in good standing with the AKC?____________ DPCA? ______________________
Have you ever been suspended from AKC or DPCA activities? ________________________
How would you like to benefit by being a member of this club? ________________________
___________________________________________________________________________
What skills or help would you like to contribute to this club? _________________________
___________________________________________________________________________

Particular areas of interest? Agility ____ Conformation ____ Obedience ____ *Rescue ____Schutzhund _____ >br? Tracking ____ Therapy ____ Other __________________
(*Refers to Rescue of homeless Dobermans, not Search & Rescue)

Are you now, or have you ever been a breeder of Dobermans? ________________________
If yes, how many litters in how many years? ______________________________________
Have you been a breeder of other breeds of dogs? __________________________________
Other comments or information: _________________________________________________
____________________________________________________________________________

I have read and understand the Code of Ethics of the Salt Lake Doberman Pinscher Club and if accepted as a member, I agree to abide by them. I understand that failure to do so may result in a request for my resignation and/or immediate expulsion from the Club.

__________________________________________________________________________ Signature of Applicant(s)

If applicant is a Junior (under 18 years of age) signature of parent or guardian is required, and, applicant understands a junior membership is a non-voting membership:
_____________________________________________ Signature of Parent of Legal Guardian

I recommend and endorse this application for membership in the Salt Lake Doberman Pinscher Club, Inc.

________________________________ ______________________________________ Signature of active member Signature of active member

Membership dues must accompany application. Regular membership dues are $10.00 annually. Family dues are $15.00 and Junior dues are $5.00. If application is rejected, dues will be refunded in full.