Application for Active Membership

Mail to: Sue Kershaw 
588 Kessell Avenue
Franklinville, NJ 0822

(Please print)

Applicant's Name: _________________________________________________ Date: _____________

Address: ______________________________________________ Telephone: # (____) ____________


Other Canine Club Affiliations: ___________________________________________________________

Are You a Fancier?_____________ Owner?___________ Breeder?____________ Judge?___________

Kennel Name, if any: ___________________________________________________________________

Do you show Dobermans in Obedience? ___________________________ Conformation?_____________

How long have you been associated with Doberman Pinscher? __________________________________

Are you in good standing with the American Kennel Club? ______________________________________

If elected to membership, I agree to actively support the Club, attend a combination of a least four (4) monthly meetings, Club
Shows, Club Matches, etc., and work in some capacity within the Club. I have attended at least one (1) meetings while
applying for membership and have known the parties sponsoring me for one year.  After applying for membership there is a 60
day waiting period before the applicant will be voted on by the club.

I have read and agree to abide by the Constitution and by-law’s of the Quaker City Doberman Pinscher Club and the rules of
 the American Kennel Club.

___________________________________   ____________

Applicant's Signature                                                                         Date

We, the undersigned, have known this applicant for one (1) year and have been participating members of the
Club. We hereby recommend and endorse the application of _______________________
__________ for
membership to the QCDPC.

______________________________ ______________________________

Sponsor                                                         Sponsor

Note: Only one application per form. The deposit of $25.00 (annual dues), payable to QCDPC is required with this application. If the
applicant is accepted, the deposit will be credited as current year’s dues. If not accepted, the deposit will be refunded. Any
applicant accepted for membership in the last quarter of the fiscal year will be considered as having paid his/her dues in full for the
following fiscal year. Please return your completed Application to the Membership Chairperson for presentation to the QCDPC for