Application for GMNEA Name(s) of Applicant(s): ________________________________________________________________________ ________________________________________________________________________ Address: ________________________________________________________________ City, State, Zip Code: ___________________________________________________ Phone: ___________________________________________________________________ Email Address_____________________________________________________________ Type of Membership & Dues Single $10.00 __________ Family $15.00 __________ For family rate, please list other members in the immediate family; Includes husband, wife, and children under 18 years of age: _____________________________________________________________________________________________ _____________________________________________________________________________________________ I (We) hereby apply for membership in the GMNEA. If accepted, I (We) agree to abide by the Constitution and By- Laws of the Association, and the rules of the American Kennel Club. Date: ___________ Signed: ________________________________________________________________ ________________________________________________________________ GMNEA Sponsors: ________________________________________________________________ ________________________________________________________________ Please enclose a check for your first year’s annual dues. Make all checks payable to: GMNEA Attn Vice President Debbie O'Brien 1562 S. 64th St West Allis, WI 43214 If additional dog survey forms are needed, please request them or scan and print more. Please complete in full. Elkhounds Owned: Owner’s Name: _______________________________________________________________________________ Dog’s AKC Name: ________________________________________________________________________ (Include any titles or degrees) Call Name: _________________________ AKC #: _________________________ Sex: _________________________ Date of Birth: __________________ Place of Birth: USA: __________ Canada: __________ Foreign: __________ Breeder: ______________________________________________________________________________________ Sire: ______________________________________________________________________________________ Dam: ______________________________________________________________________________________ Owner’s Name: _______________________________________________________________________________ Dog’s AKC Name: ________________________________________________________________________ (Include any titles or degrees) Call Name: _________________________ AKC #: _________________________ Sex: _________________________ Date of Birth: __________________ Place of Birth: USA: __________ Canada: __________ Foreign: __________ Breeder: ______________________________________________________________________________________ Sire: ______________________________________________________________________________________ Dam: ______________________________________________________________________________________ What are your main interests? 1. _____Household Companion 5. _____Pet Therapy 2. _____Obedience: 6. _____Hunting 3. _____Conformation 7. _____Tracking 4. _____Breeding 8. _____Agility 5. _____Other Past/Present activities in the dog sport, if any: __________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ In what capacity would you be willing to work in club activities? ____________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________