Username

Email

Date

Name (required)

Occupation

Name (required)

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

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.