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Username
Email
Date
Name (required)
Occupation
Address (required)
City (required)
State (required)
Zip (required)
Phone
Additional Phone#
(As a member, you will automatically be enrolled in the club email listserv group.)
Membership (2 Adults Same Address)---- Select One ---- Single $20.00 Family $30.00
List All Dog Clubs You Belong to (or Did Belong to) and Any Offices Held
My Interests Lie in---- Select One ---- Conformation Obedience Tracking Rally Schutzhund Carting Agility Herding Rescue Weight Pulling Therapy Other
Would You Consider Yourself a---- Select One ---- Show Dog Exhibitor Breeder Interested Dog Owner
Would You Be Interested in Getting Involved in Club Activities---- Select One ---- Yes No
The Committee(S) I Would Be Most Interested in Working on is
Please List All Rottweilers Currently Owned or Co-Owned by You. (Use Additional Paper If Necessary)
Registered Name
Call Name
Date Born
Sex
OFA#
AKC#
Litter#
ILP#
Sire
Sire's AKC#
Sire's OFA#
Dam
Dam's AKC#
Dam's OFA#
Purchased as---- Select One ---- Show Pet
Breeder
Please Have Your Application Endorsed by Two Club Members in Good Standing, Our Club Meetings Are Held at Dave Kellems, the Club President. Address is: 1941 Treseder Cir. El Cajon, CA 92019
Endorsed By:
Print Name
Please complete this form in its entirety and have the endorsements signed by two club members in good standing. Checks should be made payable to SRCSD and sent with this form to Carol Cobbs, 4015 Acacia Ave. Bonita, CA 91902. I (we) have read the reverse of this form and agree to uphold and abide by the Southwestern Rottweiler Club of San Diego's constitution and Code of Ethics.
Registration confirmation will be emailed to you.
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