NOBLE

National Organization of Belgian Laekenois Enthusiasts, Inc.

Membership Application

 Part I: Applicant
Please write legibly and remember to sign and date your application. Refer to the NOBLE Constitution and By-Laws Article I - Membership for more information. For a family membership, the two voting family members must be designated and can use the selections marked by 1 or 2 as appropriate.

 I (We) are applying for (check one):

__ Single membership ($20.00)
__ Family Membership ($25.00)
__ Associate membership ($10.00)

Dues are paid annually and are due on January 1st of each year. Dues payment for the current year must be enclosed with your membership application.

*Fees waived for 2008 memberships and applications.

 Applicant Name(s):
1-

2-

Mailing Address (including country):

 

 

Phone number:
1-
2-

Email Address:
1-
2-

Occupation:
1-
2-
 Number of dogs currently owned:
1-
2-
Number of Belgian Laekenois currently owned:
1-
2-

 Areas of Interest: (please check all that apply)

1_2_ Companion 1_2_ Conformation shows 1_2_ Herding
1_2_ Obedience 1_2_ Tracking 1_2_ Agility
1_ Other (please specify)
2_ Other (please specify)

 Are you aware of the genetic and hereditary conditions present in the Belgian Laekenois?

1_2_ Yes 1_2_ No

 Please note the areas in which you are willing to volunteer:

1_2_ Health 1_2_ National Shows 1_2_ Awards 1_2_ Performance Events
1_2_ Education 1_2_ Rescue
1_ Other (please specify)
2_ Other (please specify)

 The applicant(s) agree(s) to abide by the Code of Ethics, the Constitution and By-Laws of the National Organization of Belgian Laekenois Enthusiasts, Inc. and the rules of The American Kennel Club, Inc. The applicant(s) are in good standing with the AKC.
1- Appicant's Signature and date:  
2- Appicant's Signature and date:

 Part II: Sponsor
 Sponsor's Name:

 In what ways do you think the applicant will be an asset to NOBLE, the Belgian Laekenois and the sport of Purebred Dogs?

 
 Sponsor's Signature and date:

 Send completed application, signed Code of Ethics, and the appropriate fee, payable in US funds, to the NOBLE:

Randie Meyer
3 Mayhew Ln
Amherst, NH 03301
USA

  For NOBLE use only:
RBS:
BV:
PAAM:
PIN:
A/DB:
A/DM:
BOD:


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