West Highland White Terrier Club of
Southeastern Michigan, Inc.

Application for ACTIVE Membership
Active members must attend at least one meeting a year and are eligible to vote and hold office;
associate members need not attend meetings but cannot vote or hold office.

Note: If you printed this on line, please fill it out and bring it to the next meeting.

Name: ______________________________________________

Additional Household Member:___________________________

Address:_______________________________________

City/State/Zip __________________________________

Occupation ____________________________________

 Contact Numbers

Home Tele: (____)__________________________

Work Tele: (____)___________________________

Cell #: (____)_______________________________

Email: ____________________________________

Your Interest in Westies: (Circle one or more) Breeder Exhibitor Pet Owner Rescue Other (Explain)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Are you a member of any other Breed, Obedience or Kennel Club? Yes ____ No _____

If YES, please fill in the information under "Club Memberships" on page 2 of this form.

Are you presently under suspension by the American Kennel Club? Yes ____ No _____

How many Westies do you currently own? _______ Are they registered with the AKC? (or any other registry – please name ____________________________________________) Yes ___ No ____

From whom have you purchased or acquired them: (Use additional sheet of paper if needed)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

If approved for membership, are you willing to serve ACTIVELY (Committees/officers, etc.) Yes _____ No _______

Do you agree to abide by our Constitution and By-laws, Code of Ethics and the Rules of the AKC? Yes ____ No _____

Applicant’s Signature: ___________________________________ Date: ______________________

Sponsor 1 Signature: ___________________________________ Date: ______________________

Sponsor 2 Signature: ____________________________________ Date: ______________________

 

All applicants for ACTIVE status must be sponsored by TWO Active Members of the Club, in good standing. Dues are $20 per year for the active applicant and $8 for any additional household members; the household members will be considered "associate" members unless they are also present and apply for membership. A non-refundable application fee in the same amount as the dues is required at the time of application; the application will remain active for two meetings beyond the initial meeting. If the applicant has not returned for the second reading after two meetings following the initial application, the application shall expire. A new application can be made at any time but a new application fee would be required. If the applicant is accepted into the Club at the second reading, the application fee will be converted to the first year’s dues. If the applicant is rejected, a new application can be made after 6 months.

PLEASE MAKE YOUR CHECK OUT TO W.H.W.T.C.S.E.M.

Do not write below this line: (For Secretary’s use only)

Application Received: _______________ First Reading: _________________ Second Reading: ____________________

Amount of Fee Received by Treasurer: ___________________

NEXT SECTION -HERE
For Breeders, Exhibitors and those who belong to other Club Memberships.