Pomeranian Club Of Central Indiana, Inc

Application for Membership

(Please Print Clearly)

Notice: Applications must be endorsed by TWO members in good standing (a) who have been PCCI members for one (1) year or more; (b) who have known the applicant six (6) months or more; (c) who do not reside in the same household; (d) who are not related to each other or the applicant.

Applications must be accompanied by the correct dues amount. Answer all questions.

This membership application is for: REGULAR_____(Single)(Joint)______ASSOCIATE_____JUNIOR_______

Name:________________________________________________________________________________________

Occupation:____________________________________________ Telephone No_(_____)__________________

Spouse Name:_______________________________________________Occupation_______________________

Complete Address:____________________________________________________________________________

City___________________________________________State______________Zip_________________________

Work Telephone No_____________________Email Address:________________________________________

Do you participate in Rescue?__________ Were you previously a member of PCCI?_______When?_______

Are you currently a Breeder______Exhibitor_______Obedience_______Owner_______Other_____________

How many Pomeranians do you own/co-own?____________Do you own/co-own other breeds___________

Is so, which breeds?_________________Have your privileges from the American Kennel Club ever

been suspended?____________If so, Please give details__________________________________________

How many litters have you bred in the last five (5) years?_________________

Do you belong to any other breed/kennel clubs?___________List memberships in any all-breed, specialty

Or obedience clubs in which you now or have been a member. Give Dates.___________________________

_______________________________________________________________________________________________

Have you ever held office in the above club’s?_______What office or committees have you held__________________________________________________________________________________________

PLEASE NOTE: Money accompanying this application is a deposit of good intent and will be applied to membership dues upon your acceptance into the Pomeranian Club Of Central Indiana, Inc. If your membership is rejected, your deposit will be returned.

I, an applicant for membership certify that I have read and understand the Code Of Ethics and agree to abide by them and the Constitution & By-Laws of the Pomeranian Club Of Central Indiana, Inc., if elected into membership.

 

 

Applicant/s (Spouse) Signature:___________________________Signature______________________________Date:____________

Type of Memberships:

Regular Membership---- ($15.00 single/$20.00 joint) An individual applying for regular membership must attend two (2) meetings prior to submitting applications. Regular members are expected to attend at least half the meetings and take an active part in the club business and organizing events. Regular membership enjoys all privileges of the club including voting and holding office, and is open to all persons 18 & older. A husband & wife constitute a joint membership (both must reside at same address), with each individual having one vote.

Associate Membership--- ($18.00 per household) Associate members may attend all social functions and meetings and receive the newsletter. They may voice their opinions on club business, but cannot vote or hold office. They may act as committee members (with exception of the Nominating Committee) but not as chairperson. There is no requirement to attend meeting before applying for associate membership and they may re-apply for a change to regular membership at a later date.

Junior Membership--- ($5.00 single) Junior members between the ages of 10 and 17 may enjoy all the privileges of the club, but cannot vote or hold office. They may act as committee members (with the exception of the Nominating Committee) but not act as chairperson. Junior members may automatically convert to regular membership upon their 18th birthday.

Make Checks payable to the Pomeranian Club Of Central Indiana, Inc. and submit with the application. Mail to; Cathy Gould 197 E 150 N Washington, IN 47501 Email; crgould@avenuebroadband.com

 

______________________________________________________________________________________________

Sponsor - Reference #1

How long have you known the applicant? ___________Have you met the applicant in person? _________ Have you been in the applicant’s home?__________Why do you recommend the applicant(s) for membership?__________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

I, as a member in good standing, believe that the applicant(s) should be considered for the type of membership requested. (If this application is for regular membership) I know the applicant(s) and have knowledge of how they care for their dogs. I believe that they are of good character.

Print Name________________________Signature(s)___________________________________Date_________

Sponsor - Reference #2

How long have you known the applicant?___________Have you met the applicant in person?_________ Have you been in the applicant’s home?__________Why do you recommend the applicant(s) for membership?________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

I, as a member in good standing, believe that the applicant(s) should be considered for the type of membership requested. (If this application is for regular membership) I know the applicant(s) and have knowledge of how they care for their dogs. I believe that they are of good character.

Print Name________________________Signature(s)____________________________________Date_________

Do not write below this line, for official use only.

Date Application received______________ 1st Reading__________________2nd Reading_________________

Date Dues received:_____________Amount:________Check No:__________To Treasurer:________________

Membership Approved__________________Membership Rejected_____________Check sent_____________

(PCCI- revised 010808)