Bearded Collie Club of Central FL Membership Application

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Please check type of membership applying for:

Individual $10.00
Individual - Overseas $20.00
Joint $20.00
Joint - Overseas $30.00

Make checks payable to BCCCF, and mail to:

Walter Kennedy, 226 Crooked Tree Trail, Deland, FL 32724

NAME(s):

ADDRESS - STREET:

CITY:

STATE:

ZIP CODE:

PHONE:

EMAIL:

Beardie AKC Registered Name:

CALL NAME:

DATE OF BIRTH:

SIRE:

DAM:

COLOR AT BIRTH:

AKC REG NUMBER:

If you own more than one Beardie, please provide above information:

More than one Beardie::

Please choose applicable information about yourself:

Breeder
Exhibitor
Owner

Other Dog Club Affiliations:

Please indicate any area of interest:

Officer
Newsletter
Membership
Photos
Host Meetings
Match Chairman
Trophies

Other areas of interest::

I / We hereby apply for membership in the BEARDED COLLIE CLUB OF CENTRAL FLORIDA and agree to abide by it's Constitution, By-Laws, and Code of Ethics.

Date:

By checking the appropriate box below, you certify that you are the Owner of Record for the dog who's name appears in the "Registered Name" and / or "Call Name" fields, and that the information on this form is accurate.

Certified

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