Membership Application

Annual membership dues are $20/individual, $30/household; half if signing up after July 1st.

Your Name(s):_____________________________________
Address:     _____________________________________
City:        ____________ State:       ____________ Zip:____________
Phone (home):____________ Phone (cell):____________
Phone (work):____________ May we contact you at work? ([ ] yes / [ ] no)
E-mail:      _____________________________________

Would you like club minutes via emailed PDF attachments ([ ] email)
or snailmail hardcopy ([ ] snailmail)?

Who referred you to the club? _____________________________________

If you are taking or have taken agility lessons,
who is/was your instructor?   _____________________________________

With which of the following can you help (or are interested in finding out more about):

[ ] Set up equipment
[ ] Paint equipment
[ ] Desktop publishing
[ ] Do artwork

[ ] Build equipment
[ ] Repair equipment
[ ] Organize events
[ ] Provide legal assistance

[ ] Maintain Web page
[ ] Help at agility events
[ ] Tow equipment trailer
[ ] Other

Dog #1's Call Name:_________________________________________________________
Birth date:____________  [ ] Male [ ] Female
Breed:     ____________  Height at withers:____________  Inches:____________
Does this dog have agility experience? ([ ] yes / [ ] no) Level:____________
Agility Titles:_____________________________________________________________
Other Titles:  _____________________________________________________________
Other dog sports you participate in with this dog:__________________________

Dog #2's Call Name:_________________________________________________________
Birth date:____________  [ ] Male [ ] Female
Breed:     ____________  Height at withers:____________  Inches:____________
Does this dog have agility experience? ([ ] yes / [ ] no) Level:____________
Agility Titles:_____________________________________________________________
Other Titles:  _____________________________________________________________
Other dog sports you participate in with this dog:__________________________

Additional dogs:

Your membership covers any number of dogs. Attach additional dog info on a separate sheet.

Signature:                      _____________________________________
Date:                           _____________________________________
Parent/Guardian's Signature
if applicant is under 18:       _____________________________________
Parent/Guardian's printed name: _____________________________________

[ ] Individual Membership ($20) [ ] Household Membership ($30)

Make checks payable to Click N Fly Club. Mail application and check to:
Click N Fly, Courteous Canine, Inc., 3414 Melissa Country Way, Lutz, FL 33559