| Mid Central Working Dobermans Club |
Applicants Name _____________________________________________ |
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Address______________________________________________________ |
| City__________________________ State _____ Zip________________ |
| Phone #____________________ E Mail___________________________ |
| Applicants Signature_________________________________________ |
| Signature indicated applicant has read and subscribes to the MCWDC Code of Ethics and by-laws. |
| Must be 18 years of age Yes_____ NO _____ |
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| Interest & abilities you can contribute _________________________________________________ |
| How many Dobermans do you own?_____________ Have you titled any of your dogs? ______ |
| ENDORSEMENT |
| This application must be signed by an active member in good standing. This requirement is waived for the first 15 charter members. |
| I endorse the application of _______________________________________________for membership. |
| 1. ________________________________ _______________________________ _______________ |
| Print Name Signature of MCWDC DATE |
| Dues: $35.00 for single for 1 year _________ $45.00 for family _____________ |
| Make check payable to Mid Central Working Doberman’s Club and mail to: |
| 795 NE 101 Road * Warrensburg, MO 64093 |
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