Iowa State American Pit Bull Terrier Club

P.O. Box 352

Traer, Iowa 50675

(319) 478- 2542

***Membership Application***

  Date_______________

Name______________________________               Phone ________________________

Address____________________________  City_____________    State_____________

County ______________________________  Zip _________ Email ________________

Circle One:   Single Rate: $15.00               Family Rate:  $20.00

Family Rate ONLY includes members of IMMEDIATE family ONLY

List Family Members:_______________________    _____________________________

                                    _______________________   ____________________________

Circle At Least One:

Are your interests mainly:  Conformation       Weight Pull       Obedience     Agility    Herding   Other:______

Circle At Least One:

I  want  to help with:    Raffle & Fund Raising Committee      Show Committee     Refreshments Committee      Photo &  Public Relations Committee    SetUp /Cleanup Committee  Other:____________

Are you connected with any humane association, PETA/ALF/ELF groups, animal control, law enforcement or any other agency?   Yes    No    If so, which organization?  ______________________

  How or who referred you to the club? ____________________________

  How many U.K.C. registered APBT's  do you own? _______________________

Are you affiliated or associated with any other dog registry?  Yes     No

If so, which registries? __________________________   How many Other registered dogs and what breeds?_________________________________________

  I have read  the club constitution and by-laws and agree to abide by and support the rules and purposed of the club and those of United Kennel Club, Inc.  I understand that any misrepresentation of these facts or any violation of these rules forfeits membership with no refund.

No individual or group of individuals known to: promote, support, raise dogs for fighting; condone or be associated with the facing off, game testing, rolling or pitting of dogs; will be tolerated or allowed in this association. Such individuals will be banned from all U.K.C. events and clubs with no reinstatement at any time.

  Signed            __________________________        Date________________________

    Signed            __________________________        Date________________________