Please provide the following contact information. Fill in all that apply.
First Name
Last Name
Title
Member of GRCA? (Yes or No)
Kennel
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Website URL

Select any of the following areas that you are currently involved in:

Conformation
Obedience
Hunting
Tracking
Agility
Therapy
Rescue
Other

If Other ... enter information below.

Are you interested in?

Committee Work
Matches/Organization
Newsletter
Fund Raising
Public Education
Breeder Referral
Membership
Rescue/Therapy
Other

If Other ... enter information below.


By submitting this membership application you are agreeing to abide by the club's current By-Laws and Constitution and by the Code Of Ethics of the Golden Retriever Club of America, Inc: and that you are a member in good standing with The American Kennel Club.

__________________________________/______________________
(Applicant(s) Signature(s) and Date

__________________________________/______________________
(Signature of Sponsoring Member and Date)

Please Print This form, sign and return with a check made payable to,
NENYGRC, Inc. for $25.00 per individual membership or $30.00 per Family Membership to:

NorthEastern New York Golden Retriever Club, Inc.
15 Highland Court
Albany, New York 12203-5378

Now you may click Submit Form. We will hold your online application for you and you will 
be notified when your membership is processed.