Chinook Club of America, Inc.
New & Renewal Membership Application ©
The Chinook Club of America is a non-profit, volunteer organization. Membership is open to all persons 18 years and older
who subscribe to the Constitution and Bylaws of this Club, who are in good standing with the American Kennel Club, and
who are endorsed by two (2) CCA members in good standing who have both been members of CCA for a minimum of one (1)
year. Each applicant agrees to abide by the CCA Bylaws, Standard, and rules and regulations of the CCA and the AKC and to
abide by the AKC Code of Sportsmanship.
Member #1 name:
Application date:
Household member #2 name: (Family Membership)
Children under 18 years old (optional):
Kennel name (if applicable):
Address:
City, State, Zip Code:
Phone #:
E-mail address
Website address
Do you and your dogs participate or have an interest in any of the following activities? Please “X” all that apply:
Conformation shows __
Scooter/Carting __
Assistance/Therapy __
Obedience __
Hiking __
Agility __
Back packing __
Dock Diving __
Tracking __
Herding __
Dog sledding __
Breeding __
Skijoring __
Dog parks __
Weight pulling __
Search and Rescue __
Other_____________________________________________________
Are you interested in helping with a Club committee? Please “X” all that apply:
Health & Genetics __ Rescue __ Bylaws __ Standard & Judges Ed __ Show, Trial & Trail __ Publicity __ Nominations__ Specialty__
Membership dues from January thru December are $20 for an Individual membership (1 vote) or $30 for a Family Membership
(2 votes). Family Memberships may include any second household member 18 or older. Donations are greatly appreciated and
will help us develop Club activities or may be assigned to a specific committee at your request.
Send a check payable to ‘Chinook Club of America’
Or pay by using PayPal http://www.chinookclubofamerica.org/membership.html
Voting Membership
Associate
Membership
1 year
2 year
1 year
2 year
Please fill out this form and mail
via US Post Office to:
Joan McMahon
CCA Membership Secretary
7650 Rolling Oak Drive
Centerville, OH 45459
Individual
Family
__$20
__$30
__$35
__$55
__$15
__$30
Donation
__$5 __$10 __$20 Other $_____ Donate to:__________
Total Enclosed $_________________
Member # 1 Signature_______________________________________________________________________
Member # 2 Signature (Family Membership)____________________________________________________
New Member Applications Only
Please provide (2) names of current CCA members endorsing this new member application. An attached letter signed by the
sponsor, the length of time the sponsor has known the applicant and why they are endorsing the applicant is required.
Endorsing member #1___________________________________________________________________________
Endorsing member #2___________________________________________________________________________
Permission for Electronic Communication (Required)
May the club use email to notify you of club meetings, dues notices, minutes, newsletters, important
announcements, and, if applicable, board members notification of board meetings? YES
NO
Member # 1 Signature___________________________________________________Email:________________________________
Member # 2 Signature (Family Membership)_________
______________________ Email:______ ___________ ___________
CCA Annual Membership Directory (Optional)
The CCA publishes an Annual Membership Directory that, as a minimum, includes members’ names and physical
addresses. Please indicate if you would also like the following information included:
 Spouse (if not a Family Membership):____________________  Phone number
 Dog names, birth dates, performance titles, and whether the dog is altered or intact
 Email
 Website
To opt out* of publication in the Annual Membership Directory entirely, initial here: _________/_________
*Please note that a complete membership list containing names and physical addresses of all members will still be available to members by
SASE request to the Secretary as this is a requirement of both AKC and our state of incorporation. However, by opting out, names and
physical address will not be automatically distributed to all members in the form of an Annual Membership directory.
If you would like to share information about your dog(s) please fill out this form and return it with your
application and include all titles and certificates. You may copy this form to use for additional dogs.
.
Dog’s Registered Name:
Dog’s Call Name:
Conformation Titles
Neutered/Spayed?
__ Yes
__ No
Birth Date:
Conformation Titles
Neutered/Spayed?
__ Yes
__ No
Birth Date:
__ Female
Neutered/Spayed?
__ Yes
__ No
Dog’s Call Name:
Birth Date:
Conformation Titles
Performance Titles or Certificates
Dog’s Registered Name:
Conformation Titles
Gender:
__ Male
Performance Titles or Certificates
Dog’s Registered Name:
Dog’s Call Name:
__ Female
Performance Titles or Certificates
Dog’s Registered Name:
Dog’s Call Name:
Gender:
__ Male
Gender:
__Male
__ Female
Neutered/Spayed?
__ Yes
__ No
Birth Date:
Performance Titles or Certificates
Gender:
__ Male
__ Female
PHOTO RELEASE FORM
I, ________________________ hereby authorize Chinook Club of America, Inc (CCA), its
representatives, members and assigns the right to take photographs of myself, my dogs, my
agents/handlers and to publish these photographs, along with use of my name, agents/handlers,
and kennel name, in any CCA printed publications, advertisements, news articles and online
presence, including but not limited to, websites, Facebook, Twitter, etc.
I acknowledge my participation in this photo release, as it relates to CCA, is voluntary, and
acknowledge that I will receive no financial compensation, and this participation confers upon me
no rights of ownership whatsoever.
I agree that CCA may use such photographs with or without my name, kennel name or
agents/handler's names for any lawful purpose, including but not limited to publicity, illustration,
advertising, and Web content.
I release CCA, its contractors, members and assigns from liability for any claims by me or any
third party in connection with my participation.
I have read and understand the above:
Signature: _______________________________________________________________
Date: _________________
Signature Spouse (Family Membership): _______________________________________
Date: _________________
Street Address:
_____________________________________________________________________________
_____
City: ____________________________________________ State: _____ Zip: ____________