West Highland White Terrier Club of
Southeastern Michigan, Inc.

Application for ASSOCIATE Membership

Note: Associate members need not attend meetings and cannot hold officer positions or vote.

Note: If you printed this on line, please fill it out and mail it to the Membership Chair
(Dee Rakic, 278 Sisson, Romeo, MI 48065) along with the application fee.

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?
(If not the AKC, name the registry __________________________________________) Yes ___ No ____

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

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

If approved for membership, do you agree to abide by our Constitution and By-laws, Code of Ethics and the Rules of the AKC?

Yes ____ No _____

PLEASE NOTE: Associate members do not need sponsors to apply to the Club for membership; however, the use of the Club name in any advertising must be approved in writing by the Board of Directors. Please submit any such request to the Secretary of the Club and anticipate a thorough review prior to any approvals.

Applicant’s Signature: ___________________________________ Date: ______________________

All applicants for ASSOCIATE status must fill out the application, send in a non-refundable application fee equal to the first year’s dues of $20 per year for the associate applicant and $8 for any additional household members; the household members will also be considered "associate" members. The application will be considered by the Club and voted upon at the first meeting of the Club following the receipt of the completed application by the Secretary and if the applicant is accepted into the Club, the application fee will be converted to the first year’s dues. 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: _______________ Date of Reading: _________________ Approved or Not Approved ____________

Amount of Fee Received by Treasurer: ___________________

 

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For Breeders, Exhibitors and those who belong to other Club Memberships.