Date *

MM

DD

YYYY

Membership *

Check one

Adult

Junior

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Birthdate *

MM

DD

YYYY

18 Years or Older? *

Yes

No

Any special talents or abilities?

Art

Crafts

Photography

Web Design

Sewing

Computers

Dog Grooming

Woodworking

Public Speaking

Animal Health Care

Maintenance/Handyperson

Other

Have you ever belonged to a dog obedience club before? *

Yes

No

What areas of training do you do with your dogs

Obedience

Rally

Agility

Tracking

Lure Coursing

Agility

CAT/FASTCAT

Field Work

Fly ball

Herding

Scent work

Therapy

Tricks

Other

Dog 1 Sex

Male

Female

Dog 1 Birth Date

MM

DD

YYYY

Dog 2 Sex

Male

Female

Dog 2 Birth Date

MM

DD

YYYY

Dog 3 Sex

Male

Female

Dog 3 Birth Date

MM

DD

YYYY

Dog 4 Sex

Male

Female

Dog 4 Birth Date

MM

DD

YYYY

Dog 5 Sex

Male

Female

Dog 5 Birth Date

MM

DD

YYYY

Agreement *

I understand that my application constitutes an agreement to abide by the regulations, constitution, and by-laws of the Murfreesboro Obedience Training Club, Inc. I also agree to help promote responsible dog ownership and further public awareness of the importance of dog obedience training. I am in good standing with the American Kennel Club.

I Accept