Shih Tzu Club of Wisconsin’s Fox Valley

Membership Application

”We shall endeavor to do all in our power to protect the health and welfare of the Shih Tzu breed by urging members and breeders to accept the AKC-approved breed standard, as maintained by the American Shih Tzu Club, as the only standard of excellence by which Shih Tzu shall be judged, and follow the Club’s Code of Ethics as adopted.  We shall also advance the interests of the breed by providing educational programs, encouraging sportsmanlike conduct and competition at all times.”

Please answer the following questions.  Please PRINT.

NAME:  _________________________________________________    TELEPHONE:  ________________________________

ADDRESS: _______________________________________________    EMAIL:  ____________________________________

CITY:       _____________________________________ OVER 18 YEARS OF AGE?  _____________YES _____________ NO

STATE & ZIP: __________________________________

I am interested in:  _____Conformation _____ Breeding _____ Agility/Obedience _____ Pet Ownership Only

Please list any other breeds you have owned:  __________________________________________________________

                                                ____Show   ____ Breed   ____ Pet Only

Please list any other clubs 1) you have belonged to in the past or 2) are of which you are a current member, and how long you have been a member of the club.

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Did you hold any offices or serve on any of its committees, if so, in what capacity?  ______________________________________

Do you have any hobbies other than your dogs, if so, what are they?  _________________________________________________

Please list any special interests/talents you may have:  ____________________________________________________________

Would you be interested in serving in the following areas?  Please check all that apply:

____Match/Specialty Shows                  ____Officer or Board Member                                ____Program Committee

____Newsletter                                      ____Trophies                                          ____Nominating Committee

____Annual Club Banquet (Dec.)           ____Picnic (July)                                     ____Other

I hereby make application for membership to the Shih Tzu Club of Wisconsin’s Fox Valley.  I have read and agree to abide by the Club’s Code of Ethics and will, to the best of my ability, pursue and uphold the purposes of the Club as set form in the Constitution and Bylaws.  I have enclosed my dues in the amount of:

                _____ $15.00 Regular             _____ $20.00 Household        _____ $10.00 Junior       _____ $15.00 Associate

(Explanation of membership types:  Regular is a single, individual membership; Household is more than one adult residing at the same address along with any children; Junior is anyone younger than 18 yrs. Of age; Associate is anyone living outside the local area, cannot participate at our regular local club meetings, but would like to continue to be apprised of club events.)

I understand that any false information knowingly provided by me may affect my acceptance into the STCWFV.

Signed:  _________________________________________________________Dated:  ______________________________

Applicants need to have two sponsors from the Shih Tzu Club of Wisconsin’s Fox Valley

Please have your sponsor fill in their names below and their affiliation with you.

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