New & Renewal Membership Application © /
The Chinook Club of America is a non-profit, volunteer organization. Membership is open to all persons 18 years and older who subscribe to the Constitution and Bylaws of this Club, who are in good standing with the American Kennel Club, and who are endorsed by two (2) CCA members in good standing who have both been members of CCA for a minimum of one (1) year. Each applicant agrees to abide by the CCA Bylaws, Standard, and rules and regulations of the CCA and the AKC and to abide by the AKC Code of Sportsmanship.
Member #1 name: / Application date:
Household member #2 name: (Family Membership)
Children under 18 years old (optional):
Kennel name (if applicable):
Address:
City, State, Zip Code:
Phone #: / E-mail address / Website address
Do you and your dogs participate or have an interest in any of the following activities? Please “X” all that apply:
Conformation shows __ Obedience __ Agility __ Tracking __ Dog sledding __ Skijoring __ Weight pulling __
Scooter/Carting __ Hiking __ Back packing __ Herding __ Breeding __ Dog parks __ Search and Rescue __
Assistance/Therapy __ Dock Diving __ Other______
Are you interested in helping with a Club committee? Please “X” all that apply:
Health & Genetics__ Rescue __ Bylaws __ Standard & Judges Ed __Show, Trial & Trail __ Publicity __ Nominations__ Specialty__
Membership dues from January thru December are $20 for an Individual membership (1 vote) or $30 for a Family Membership (2 votes). Family Memberships may include any second household member 18 or older. Donations are greatly appreciated and will help us develop Club activities or may be assigned to a specific committee at your request.
Send a checkpayable to ‘Chinook Club of America’
Or pay by using PayPal Voting Membership Associate Membership
1 year 2 year 1 year 2 year
Please fill out this form and mail
via US Post Office to:
Joan McMahon Individual __$20 __$35 __$15 __$30
CCA Membership Secretary Family __$30 __$55
7650 Rolling Oak Drive
Centerville, OH45459 Donation __$5 __$10 __$20 Other $_____ Donate to:______
Total Enclosed $______
Member # 1 Signature______
Member # 2 Signature (Family Membership)______
New Member Applications Only
Please provide (2) names of current CCA members endorsing this new member application. An attached letter signed by the sponsor, the length of time the sponsor has known the applicant and why they are endorsing the applicant isrequired.
Endorsing member #1______
Endorsing member #2______
Permission for Electronic Communication(Required)
May the club use email to notify youof club meetings, dues notices, minutes, newsletters, important announcements, and, if applicable, board members notification of board meetings? YES NO
Member # 1Signature______Email:______
Member # 2 Signature (Family Membership)______Email:______
CCA Annual Membership Directory (Optional)
The CCA publishes an Annual Membership Directory that, as a minimum, includes members’ names and physical addresses. Please indicate if you would also like the following information included:
Spouse (if not a Family Membership):______ Phone number Email Website
Dog names, birth dates, performance titles, and whether the dog is altered or intact
To opt out* of publication in the Annual Membership Directory entirely, initial here: ______/______
*Please note that a complete membership list containing names and physical addresses of all members will still be available to members by SASE request to the Secretary as this is a requirement of both AKC and our state of incorporation. However, by opting out, names and physical address will not be automatically distributed to all members in the form of an Annual Membership directory.
If you would like to share information about your dog(s) please fill out this form and return it with your application and include all titles and certificates. You may copy this form to use for additional dogs.
.
PHOTO RELEASE FORM
I, ______hereby authorize Chinook Club of America, Inc (CCA), its representatives, members and assigns the right to take photographs of myself, my dogs, my agents/handlers and to publish these photographs, along with use of my name, agents/handlers, and kennel name, in any CCA printed publications, advertisements, news articles and online presence, including but not limited to, websites, Facebook, Twitter, etc.
I acknowledge my participation in this photo release, as it relates to CCA, is voluntary, and acknowledge that I will receive no financial compensation, and this participation confers upon me no rights of ownership whatsoever.
I agree that CCA may use such photographs with or without my name, kennel name or agents/handler's names for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web content.
I release CCA, its contractors, members and assigns from liability for any claims by me or any third party in connection with my participation.
I have read and understand the above:
Signature: ______Date: ______
Signature Spouse (Family Membership): ______Date: ______
Street Address: ______
City: ______State: _____ Zip: ______