Irish Setter Club of Central Connecticut
Membership Application

I hereby apply for membership in the Irish Setter Club of Central Connecticut.  I am currently in good standing
with the American Kennel Club.  I enclose annual membership dues as indicated below.

(   ) $15.00   Individual Membership (open to persons 18 years of age and older)
(   ) $20.00 Family Membership (two members 18 years of age and older, shall include children up to age 18)

Date of Application:___________________________

Name:__________________________________________  Signature:_____________________________________
Spouse or Partner:________________________________  Signature:_____________________________________
Address:________________________________________   City:__________________ State:______ Zip:________
Phone: (____)_________________________                        Email:________________________________________
Occupation(s):___________________________________   _____________________________________________
Proposed by:___________________________________  and _____________________________________
(Two members shall propose an applicant.  A letter of recommendation shall be submitted by at least one of them.)

To be eligible for membership, you must have attended at least two Club functions, one of which shall be a
general membership meeting.  Please list the two functions, with dates:

_______________________________________  _____________________________________
Please complete the following for our records:
How long have you been interested in Irish Setters? _________________  How many have you owned?__________
Name of current dog(s):____________________________________________________________________________
# of litters bred and registered with AKC:_____    Kennel name, if any:_________________________________
Ever exhibited a Setter at an AKC show? ______  Ever run a Setter in an AKC field event?____________
To what Kennel Clubs have you belonged (past or present)?______________________________________________
________________________________________________________________________________________________

Your interests: (   ) Conformation    (   ) Obedience    (   ) Field    (   ) Agility    (   ) Other:______________________

Committees you are willing to work on (Please circle):
Annual Awards       Membership       Parade          Programs       Specialty Show       Trophies              
Hospitality               Newsletter          Property       Rescue            Sunshine                  Versatility                 

Use the reverse side for any additional interests that may be useful in club activities or other comments.

Please send your completed application, after you have attended the required club events, with your check to:
Sandy Seymour, 45 Piper Cross Rd., West Springfield MA 01089.

The Board of Directors will consider your application at the next board meeting.  It will then be voted upon at
the following general membership meeting.

Club Use Only
Approved/Rejected: Date____________ Check #__________ Notified in person/by letter______________