Grand Canyon State Rottweiler Club Membership Application
Please fill out application completely.
Attach as many additional sheets of paper as necessary to completely respond to all questions. The
GCSRC Board of Directors reserves the right to request additional information and/or ask for clarification of responses.
Name(s):__________________________________________________________
Address:___________________________________________________________
Home Phone:_______________________________________________________
E-Mail Address:____________________________________________________
Kennel Name (if any):________________________________________________
Occupation(s):______________________________________________________
1. Do you currently own one or more Rottweilers?
Yes_____ No_____
How many?_____ How long have you owned Rottweilers?___________
2. List the following information for ALL Rottweilers you currently own.
Use separate paper if necessary.
__________________________________________________________________
Registered
Name:_________________________________________________________
AKC Number (if any):_____________________Date of Birth:___________Sex:___
Breeder:___________________________________________________________
OFA, CERF #s (if any):______________________________________________________________
Other Certifications?_________________________________________________
Sire:_____________________________Dam:_____________________________
Co-owner (if any):___________________________________________________
Dog's Titles (if any):_________________________________________________
__________________________________________________________________
3. Have you ever exhibited your Rottweiler(s) in
Conformation, Obedience, Tracking, Herding, Agility, Schutzhund, Other? Yes_____ No_____
4. Is your Rottweiler trained in a special activity
such as Therapy, Search and Rescue, Attack/Guard Work, etc? Yes_____ No_____
In what areas?
__________________________________________________________________
5. Are you a member of any other dog clubs?
Yes_____ No_____
If yes list club(s) and offices held (if any):________________________________
6. Are you a licensed judge? Professional handler?
Professional trainer? Are you affiliated with or act as an agent or broker for any type of dog-related
business?
Yes_____
No_____ If yes, please give specific details on a separate sheet of paper.
I/we hereby apply to the Grand Canyon State
Rottweiler Club for membership (check one):
_____ Single Membership
($20 per year): one (1) person, 18 years of older, who currently owns a Rottweiler, and is in good standing
with the American Kennel Club. Individual is entitled to one (1) vote after attending two (2) GCSRC meetings.
_____ Household Membership ($30.00 per
year - 2 votes per family): more than one member of a given family residing in the same household, 18 years
or older, who currently own a Rottweiler, and are in good standing with the American Kennel Club. Each
member entitled to one vote after attending two GCSRC meetings.
_____ Associate Membership ($10.00 per year): One (1) person, 18 years or older,
who currently does not own a Rottweiler, is in good standing with the American kennel Club. Individual
is not entitled to hold office or vote. May change status to Single Membership when (s)he becomes an owner
of a Rottweiler and proof of ownership is supplied.
I/we have completed
this application in a true and accurate manner. I/we declare that I am/we are 18 years of age or older,
in good standing with the American Kennel Club, and agree to read and abide by the Constitution, Bylaws, and Code of Ethics
of the Grand Canyon State Rottweiler Club.
________________________________________________________________________
Signature of Applicant
Date
________________________________________________________________________
Signature of Applicant
Date
*
As stated in Section 3 of the Grand Canyon State Rottweiler Club Bylaws, each applicant must carry the endorsement of two
current members in good standing. In order to become a voting member, each applicant must attend two Grand
Canyon State Rottweiler Club meetings. This application will be submitted to the Secretary, and will be
voted on by the Board of Directors at the following Board meeting. The application must pass with a 2/3
affirmative vote by the Board. The application will then be presented at the following club meeting to
be voted upon by secret ballot, and must pass with a 2/3 majority vote of those members present at that meeting.
Club dues are due upon election into the club.
__________________________________________________________________
Endorsement of Member #1
Date
__________________________________________________________________
Endorsement of Member #2
Date
