First Name:______________ Last Name:_________________

Address: _________________________________________

City: ___________  Prov/State:__   Postal Code : __________

Email Address:_____________________________________

Dog’s Call Name:___________________________________

Dog’s Reg. Name:___________________________________

Do you groom your own dog (clipping or hand stripping): 

yes o no o

Would you be interested in a Grooming Workshop (clipping and hand stripping):  

yes o no o

Are you a member of the Canadian Kennel Club(CKC): 

yes o no o 

Airedale Terrier Canadian Club(ATCC): 

yes o no o

Which event(s) are you interested in: 

Spring Annual Fun Day o  

Fall Annual Fun Day o  

Rescue o

Breed Booster/Specialty o  

Obedience/Agility o  

Hunting/Working o  

Grooming Workshop o

Breed info. o  

Others:

How many hour(s) a year would you be willing to commit:______

What committee('s)/event(s) are you interested in volunteering on:

Spring Annual Fun Day o

Fall Annual Fun Day o  

Rescue o  

Breed Booster/Specialty o  

Obedience/Agility o  

Hunting/Working o  

Grooming Workshop o  

Breed info. o  

Others:

Will allow my name, address and phone number to be published in the Roster list available to members: 

yes o no o

What activities are you currently involved in with your dog:

 ____________________________________________

 ____________________________________________

 ____________________________________________

 ____________________________________________

Breeding Information

Breeder:

 yes o no o  

If 'yes', please answer the following:

Kennel Name:________________________________

No. of years in Airedale Terriers:________________

CKC Registered Kennel: yes o no o

Comments: