CHINOOK OWNERS ASSOCIATION, INC. 2005 MEMBERSHIP FORM

Your Name:

Date:

2nd Member Name (Spouse/Housemate/Child 18+):

Junior Member(s) under age 18 (Non-voting):

Your Kennel Name (if applicable):

Address:

City, State, Zip Code:

Home Phone:

Work Phone:

Fax:

E-mail Address(es) — Please use the correct case and print carefully:

Website Address:

Add Link on COA Member Website?

o Yes o No o It’s already linked

Please complete the following for each Chinook or Chinook Cross that you own. Include all conformation, obedience and working titles. If you have more than two dogs, there are extra forms on the last page. If you have more than five dogs, please attach an extra sheet of paper or photocopy the forms.

Dog’s Registered Name:

Sex:

o Male o Female

Dog’s Call Name:

Birth Date:

Neutered/Spayed?

o Yes o No

U.K.C. #:

COA#:

OFA # (or results):

CERF:

o Yes o No

DNA:

o Yes o No

DNA-VIP:

o Yes o No

Tattoo or Microchip:

Dog’s Registered Name:

Sex:

Dog’s Call Name:

Birth Date:

Neutered/Spayed?

o Yes o No

U.K.C. #:

COA#:

OFA # (or results):

CERF:

o Yes o No

DNA:

o Yes o No

DNA-VIP:

o Yes o No

Tattoo or Microchip:

o I do not currently own a Chinook but wish to support the COA and receive the quarterly newsletter.

The above information will be recorded in the COA database and will be included in the annual Member- ship Directory. We hope it will help you to better know the members of the COA and perhaps be a helpful reference for your breeding plans. If for any reason you do not wish to have your phone or Fax numbers or information about your dog(s) included in the directory please note that on this form. The 2005 dues structure is $25 for a single membership (1 vote) or $35 for a family membership (2 votes). This may be a spouse, partner, housemate or child 18 or older. Children under 18, with a paid membership in the household, may be non-voting junior members with no dues required.

Please send dues payable to ‘COA’ to:

Laura Morgan, COA Membership Chair, 212 Overlook Road, Ithaca, NY 14850

 
1 Year

August 1 - Dec*
Single
$25

$13
Family
$35

$18

* After October 1, dues carry over to the next calendar year.

In addition to the membership fee, breeders can choose to list themselves with the COA for a fee of $50. This fee will entitle the COA member breeder to receive referrals from the Publicity Chairperson, to be listed as a Member Breeder on the COA website, to list studs on the COA website and to all other services that the COA may, from time to time, offer to its Member Breeders.

OR for those who have a stud they wish to advertise, there is the option of only listing their stud(s) on the webpage for a fee of $25. This fee is also in addition to the membership fee. Any stud can be listed regardless of known or unknown health defects and the COA will maintain a strict disclaimer about the health of the listed studs on the page. The fee will entitle the stud owner to list two pictures of the stud on the web page along with any statistics the owners wish to list, including but not limited to: health, pedigree, working status, progeny, age, size. If you would like to make a donation to the COA, please specify where you would like your contribution to be used.

Please total:

Dues (circle appropriate category above): $

Breeder Fee: $

Stud Fee: $

Contribution: $

TOTAL DUE: $________________________________

 

Signature: _________________________________________________________ Date: ___________________

Thank you so much for joining us. We are happy to have you as part of the COA!