Membership Application

Please Note: Each member of LMCWCC must attend 1 (one) meeting/event/function per year to maintain his/her membership.

Types of Membership:

• Individual Membership ($15 per year) – Single adult (with voting rights)
• Household Membership ($25 per year) – 2 Adults (2 adults having voting rights)
• Associate Membership ($10 per year) – wants to support club (no voting rights)
• Junior Membership ($2 per year per junior) Ages 5-17 years
  Membership Application

  Membership Type Requested

  Individual

  Household

  Associate

  Junior

  First Name

  Last Name

  Email

  Phone/Mobile

  Date of Birth

  AKC Junior number

  Second Member's Information

  First Name

  Last Name

  Email

  Phone/Mobile

  Address

  Address Line 1

  Address Line 2

  City

  State

  Zip Code

  Country

  Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe

  Kennel Name (if any)

  Have you ever been suspended or fined by AKC or any other club?

  Yes

  No

  Have you ever been cited by an Animal Control organization?

  Yes

  No

  Have you ever been associate with a wholesale or retail pet sales opperation?

  Yes

  No

  Provide Dates and Details here.

  How long have you been involved in Cardigan Welsh Corgis?

  How many Cardigans do you currently own?

  List all Cardigan Welsh Corgis that you currently own with call names, registered names, and their breeders.

  How long have you bred Cardigan Welsh Corgis?

  How many litters of any breed or mix have you had in the past 3 years?

  Other breeds do you own or have owned:

  Are you currently breeding any of these other breeds?

  Yes

  No

  Do you participate in AKC events?

  Yes

  No

  What year did you begin?

  Please list all areas you are involved with (e.g. breeding, obedience, herding etc):

  List all interests you would like to learn more about with your Cardigan Welsh Corgis (e.g. grooming, health, herding, handling, etc)

  What special talents or areas of interest do you have that you would be willing and able to contribute to/share with LMCWCC.

  If you now or have been a member of a breed club, kennel club, or a dog performance club please list the names of the clubs, dates of membership, offices held (if any), and your involvement with the club.

  Please list two dog-related references who have known you for more than one year. Please include name, telephone number, email address and years known.

  I/We hereby apply for membership in the Lake Michigan Cardigan Welsh Corgi (Regional) Club.  If accepted, I/We agree to abide by LMCWCC's Constitution, By-Laws and Code of Ethics.  I/We understand that failure to do so may result in expulsion as a member of LMCWCC.  

  Please indicate this by typing your complete name and including the current date of application. 

  Type name in lieu of signature:

  Date

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  Payment Method

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