Israel Canaan Dog Club of America, Inc.

Membership Application


Type of Application: ________ Single (1 vote) _________ Family (1 household, 2 votes, 1 newsletter)


Memberís name: _________________________________________

Occupation: __________________________________________

Address: ___________________________________________________________________

City: ________________________ State: _____ Zip:________ Country: ________________

Home Phone: _________________________

Other phone numbers (mobile, fax, work, etc): _____________________________________________

Email: ______________________________________________ (Membership renewals and infrequent notices will be emailed when possible to reduce club expenses.)

If family membership, 2nd Adultís name: _____________________________________

Occupation: ________________________ Email: ____________________________________

Childrenís names: ______________________________________________

Kennel Name (if any): ______________________________________________________

How did you hear about the breed? ______________________________________________________

How did you hear about the club? ______________________________________________________

Average number of dogs you have: ______ Breeds: _______________________________

If you have a Canaan: When did you acquire your first?___________ How many do you have? _________

If you do not have a Canaan: Do you plan to get one in the next year? ____________

If so, what breeder, if any, have you selected? ______________________________________

List all dog related clubs to which you have belonged or do belong, dates of membership and positions held:

______________________________________________________________________________________

______________________________________________________________________________________

In what sports/activities do you and your dog(s) currently participate? (please circle)

Pet Breeding Conformation Obedience Agility Herding Tracking Other:_______

Areas of future interest: (please circle)

Pet Breeding Conformation Obedience Agility Herding Tracking Other:_______


List all Canaans you have had in the last 5 years (please use additional page if more space is needed).

Call name: ___________________________ Call name: ___________________________

DOB: _______________________________ DOB: _______________________________

Breeder: _____________________________ Breeder: _____________________________

Registered name: ______________________ Registered name: ______________________

All titles earned: _______________________ All titles earned: _______________________

Registries: ____________________________ Registries: ____________________________

Male or Female: _______________________ Male or Female: _______________________

Intact or Neutered: _____________________ Intact or Neutered: _____________________

Number of litters sired or whelped: ________ Number of litters sired or whelped: ________

If you have been a breeder during the last 5 years, list the breed and numbers of litters of each breed you have whelped other than the Canaans listed above:

______________________________________________________________________________________

List championships or titles that you have completed other than the Canaans listed above:

______________________________________________________________________________________

The ICDCA is an all volunteer organization. Please circle the areas in which you can help.

* desktop publishing , e.g., producing a newsletter, premium list, catalog, other club's publication projects

* other computer skills, e.g., databases, web pages, etc

* art, crafts, photography, photo editing, movie production (videotape of course)

* writing, e.g., contributing articles, brochures, posting on bulletin boards, etc

* people skills, e.g., contacts with members, with the general public

* PR skills, e.g., enhancing the visibility of the Club in the dog world

* professional skills, e.g., knowledge of law, veterinary, genetics, accounting, other __________

* dog show experience, e.g., specialty tasks: show secretary, steward, trophies, hospitality, etc

* other skills _________________________________________

Please explain why you wish to be a member of the ICDCA:

______________________________________________________________________________________

______________________________________________________________________________________

I agree to abide by the Constitution, By-Laws, and the Code of Ethics of the ICDCA and by the rules and regulations of the United Kennel Club. I understand that until my application is approved, I will be a Provisional Member of the ICDCA with all the membership privileges but without the right to vote. In case my application were not approved, the ICDCA is not be obligated to make the reasons known to me and my Provisional Membership will be converted to a newsletter subscription.

Signature(s): ________________________________ Date: _____________

________________________________ Date: _____________


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