Use this form to apply for BMDCR membership. You will also need to provide:
First Name: Last Name:
Street:
City: State: Zip:
E-Mail:
Home Phone:
Work Phone:
Cell Phone:
Occupation:
Are you a U.S. Citizen? Y N
Bernese Mountain Dogs You Own (send another application with your name if you need to add more dogs)
Name: AKC No:
Birthdate (dd/mm/yyyy): Male Female
Sire:
Dam:
Breeder:
Please Indicate your interests
Family Pet Health Issues Tracking Agility
Draft (Carting) Backpacking Herding Search & Rescue
Obedience Conformation Breeding Therapy Work
Other:
Why do you want to join the BMDCR?
How did you learn about the BMDCR?
Who do you know in the club?
What contributions are you willing to make to promote the activities of the club?
List the breed(s) you own now and those you have owned in the past:
Do you train your dogs? Y N
If so, in what areas?
How long?
Do you show your dogs? Y N
Breeding
Have you ever bred a litter of puppies? Y N
Did you register with the AKC? Y N
How many litters?
What breeds?
Clubs and Professional Activities
Have you ever been a handler or a judge at a licensed dog show or fun match? Y N
If so please give specifics:
Are you a member of any other dog clubs? Y N
Were you ever a member of any other dog clubs in the past? Y N
List other clubs (including BMDCA) with effective dates:
Are you now or have you ever been an officer in a dog club? Y N
If so list offices and dates of services:
Have you ever been suspended, expelled, or denied membership in any dog organization?
Y N
If yes please give full particulars:
Membership Directory Preferences
For our membership directory do you want your dogs listed too? Y N
Please indicate how you wish to receive the BMDCR newsletter:
E-mail U.S. Postal Service (additional $5.00 fee)
Please indicate the categories below that you wish to have listed following your name:
Owner Exhibitor Obedience
Agility Tracking Herding
Draft (Carting) Therapy Dog
