| Your
Name*:
|
|
| Spouse's
Name: |
|
| Address*: |
|
| City*:
State*:
Zip*:
|
| Country
(if other than the US): |
|
Phone Number*:
|
(H)
(W) |
| Your
Email Address*: |
|
| Occupation: |
|
Do
you currently have a Tibetan Mastiff?
Yes No
(*Not a requirement
for membership) |
|
If yes, please provide the
following information for each TM you own or co-own: Registration Number, Registered
Name, Sex, Date Whelped, Breeder, from whom purchased, and date purchased.
|
| Have
you bred a litter(s) of TMs in the last five years?
Yes No |
If yes, please provide the
following information for each TM litter: Litter Registration Number, and Date
Litter Whelped.
|
Are
you now exhibiting your TMs or do you intend to exhibit?
Yes No
Conformation:
Tracking: Obedience:
Schutzhund:
|
| Is
your TM trained in some special activity?
Yes No |
| If
yes, please indicate the type of activity (Example: Rescue Work, Attack or Guard
Work, etc.)
|
| Have
you ever been a handler or judge at an ATMA or other dog club licensed dog show
or sanctioned or fun match?
Yes No |
| Do
you now or in the past own(ed) other breeds of dogs?
Yes No |
| If
yes, please provide the following information: Breeds and Number of dogs of each
breed owned, and Litters bred for each breed.
|
Do
you exhibit your other dogs?
Yes No
Conformation:
Obedience:
Tracking: Schutzhund:
|
|
Please list all dog club affiliations,
both in the USA and any foreign country, and also list how long you have been
affiliated with each dog club:
|
Are
you now or have you ever been an officer in any other dog club?
Yes No
If yes, please
specify position(s) held:
|
Have
you ever been suspended or expelled from any dog organization?
Yes No
If yes, please explain:
|
Do
you advertise in any of the following?
National Dog Magazines:
Breed Magazines: Newspapers:
Breed Club Newsletters:
Farm Publications:
If so, please identify where:
|
Do
you or any member of your family have an affiliation with any type of animal-related
business such as pet stores, grooming, boarding kennels, or act as a dog broker
or sales agent? Yes
No
If yes, please explain:
|
Do
you have any specific qualifications which would be of service to our club?
Yes No
If yes, please
describe:
|
|
Briefly state how you became
interested in and acquainted with the Tibetan Mastiff breed:
|
|
Briefly state your reasons
for becoming a member of the ATMA. In addition,
were you ever a member of ATMA, and if so, why did you leave, and why do you now
wish to rejoin?
|
|
With the view
to the protection and betterment of the breed of dog known as the Tibetan Mastiff,
I/We agree to abide by the Constitution and the By-Laws of this Club which is
to create and promote a healthy interest in the Tibetan Mastiff. I/We agree to
abide by the rules and regulation of the American Kennel Club.
APPLICANTS:
I/We certify that I/We have answered the above questions in a true and correct
manner:
Applicant (1) Signature:
Date:
Applicant (2) Signature:
Date:
SPONSORS: Please list the names of two
ATMA members in good standing with ATMA who will be your sponsors:
Sponsor
(1) Name:
Sponsor (2) Name:
I
understand that this application will be acted upon at the next meeting of the
Board of Directors of the Club, and that, if not accepted, the dues submitted
herewith, will be promptly refunded. |
