American Kennel Club, 260 Madison Avenue, New York, NY 10016-2401

American Kennel Club, 260 Madison Avenue, New York, NY 10016-2401

Delegates Credentials

This part of a Delegate’s credentials form is to be completed by the person who has been proposed by a member club as its Delegate candidate and returned to the Secretary, American Kennel Club, 260 Madison Avenue, New York, NY 10016-2401. All candidates for the position of Delegate, approved by the Board of Directors, shall be notified in writing within five days of their approval. Approved candidates shall be considered seated as of the date of receipt of written notification.

Name ______

Home Address ______

Telephone ______Cell ______Fax______

Business______Email ______

Are there any of the above numbers that you DO NOT wish to be printed in the yearly Delegate’s Directory? If so,

please indicate which ones: ______

Business or Occupation, or Profession ______

Name of Company ______

Describe Nature of Business ______

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Business address ______Telephone ______

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Give the name of the breeds in which you have had or have an interest: ______

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To what extent have you bred dogs of the above-named breeds or breeds, i.e., number of litters registered: _____

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Have you been or are you currently interested in:Exhibiting dogs in dog shows? Yes No 

Exhibiting dogs in obedience trials? Yes No 

Exhibiting dogs in field trials? Yes No 

Do you receive any form of remuneration for exhibiting dogs?Yes No 

Are you currently an AKC-licensed judge for conformation, obedience, or junior showmanship?Yes No 

If Yes, what is your AKC Judges Number? #______

Do you train dogs (other than dogs owned by you) either individually or in classes through their handlers? If Yes, explain

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Have you, within the last 12 months, been serving regularly as an instructor of an organized dog training class or classes?

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Do you receive compensation for these classes? ______

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Are you connected in any way with a publication disseminating dog news or carrying dog advertising? If so, give thename of the publication and describe your position:

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Are you connected in any way with a dog food, dog remedy or kennel supply company? ______

If you are, give the name of the company and its address: ______

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Describe your position ______

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Have you engaged in dog transactions that were not connected with your own breeding program or with your activities as an exhibitor in dog shows, obedience trials, or field trials? If yes, describe these transactions.

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Have you previously served as a Delegate? List all dog clubs of which you are a member or have served as a Delegate. No member of a club which distributes part of any profit derived from the conduct of events to its members may become a Delegate after November 10, 1997.

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I fully understand that a person who accepts more than actual expenses in connection with a judging assignment is ineligible to become or remain a Delegate.

Date______

Signature

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Name of Club

ACDEL1 (12/05)