Canadian Polish Lowland Sheepdog Club, (CPONC) Inc.
Membership Application Form (print and send)

TYPES OF MEMBERSHIP
Individual: any individual 18 years or older who is presently or has formerly been the owner of a PONs. This classification shall entitle such a member to one (1) vote in any authorized election of the club.
Associate: any individual 18 years or older that does not not ever has owned a PON. This classification also includes Foreign members. This type of membership cannot vote, hold office, nor do they count in determining a quorum.
Honorary: This classification shall include any individual eighteen years of age or older who has made significant contribution to the benefit and advancement of Pons.  This classification may include foreign membership and shall be granted by approval of the Board.  This type of membership cannot vote, hold office, nor count in determining a quorum.

MEMBER INFORMATION: (Please PRINT)

Name: __________________________________________________________________________________

Address: ________________________________________________________________________________

City: _____________________________________________ State/Province:__________________________

Zip/Postal Code:________________ Country:_________________

Telephone: (Home)___________________ Work: ___________________ Fax:_________________

e-mail address:________________________________________________________________________

PON INFORMATION:

Registered Name: ________________________________________ Call Name: ____________________

Sire:___________________________________ Dam:___________________________________

Date of Birth:__________ Sex:____ Color: _____________ Breeder: _____________________________

Show Results to date, if any: _________________________________________________________________

SPONSORED BY: ( two sponsors are required )

Sponsor # 1: ________________________________________________________ Date: ___________________

Sponsor # 2: ________________________________________________________ Date: ___________________

TYPE OF MEMBERSHIP: All dues are payable in Canadian dollars

_______ Individual: $35.00      __________  Associate/Foreign: $35.00

I (we) agree to abide by the Constitution and by-laws of the Canadian Polish Lowland Sheepdog (CPONC) Inc.,

Signature:___________________________________________________________ Date:______________________ 

Signature:___________________________________________________________ Date:______________________
Make check payable to: CPONC, Inc.
Mail to: CPONC, Inc. 5405, rue Dugal,  Boischatel (QC)  G0A 1H0