Name:_________________________________________________________ Breed(s)_______________________________
Address:__________________________________________________ City:_______________________,MI Zip_________
Phone: ( )___________ Fax: ( )___________ Email:__________________________________________________
Voting Districts: U.S. Congress:_______ MI House:_______ MI Senate:_______ Municipality:_____________
(Info is on your Voter Registration Card, or obtainable from your City, Village or Twp Clerk, as applicable)
Your Other Dog Club Affiliations:
_____________________________________________________________________________________________________
JOBS YOU CAN OR MIGHT HELP WITH:
Dog Show Booth_______ Obtain Data from Internet_______Contact Gov’t Officials_______
Attend MI Legislative Hearings_______Local Municipal Meetings_______Other_______
Indicate whether this Application is for a New____ or Renewal____ Membership
Mail (with a $10 check for one year’s dues) to MAPBD Membership Secretary:
Donna Machniak, 237 Groveland Dr., Howell, MI 48843
Your Ideas and Comments to MAPBD BOARD:
__________________________________________________________________________________________
Club Name:______________________________________________All Breed_____ Specialty:Breed_____ Group_____
Club Secretary Name:________________________________________________________
Address:__________________________________________ City:____________________ ,MI Zip__________
Phone: ( )________ Fax: ( )_______Email:__________ ____Club Website:_____________________
Please Provide the Same information as above for Your Club's Two Delegates to Interface with MAPBD:
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Indicate whether this Application is for a New____ or Renewal____ Membership
Mail (with a $20 check for one year’s dues) to MAPBD Membership Secretary:
Donna Machniak, 237 Groveland Dr., Howell, MI 48843
Your ideas and comments to MAPBD BOARD:
__________________________________________________________________________________________
Address:__________________________________________________ City:_______________________,MI Zip_________
Phone: ( )___________ Fax: ( )___________ Email:__________________________________________________
Voting Districts: U.S. Congress:_______ MI House:_______ MI Senate:_______ Municipality:_____________
(Info is on your Voter Registration Card, or obtainable from your City, Village or Twp Clerk, as applicable)
Your Other Dog Club Affiliations:
_____________________________________________________________________________________________________
JOBS YOU CAN OR MIGHT HELP WITH:
Dog Show Booth_______ Obtain Data from Internet_______Contact Gov’t Officials_______
Attend MI Legislative Hearings_______Local Municipal Meetings_______Other_______
Indicate whether this Application is for a New____ or Renewal____ Membership
Mail (with a $10 check for one year’s dues) to MAPBD Membership Secretary:
Donna Machniak, 237 Groveland Dr., Howell, MI 48843
Your Ideas and Comments to MAPBD BOARD:
__________________________________________________________________________________________
Club Name:______________________________________________All Breed_____ Specialty:Breed_____ Group_____
Club Secretary Name:________________________________________________________
Address:__________________________________________ City:____________________ ,MI Zip__________
Phone: ( )________ Fax: ( )_______Email:__________ ____Club Website:_____________________
Please Provide the Same information as above for Your Club's Two Delegates to Interface with MAPBD:
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
Indicate whether this Application is for a New____ or Renewal____ Membership
Mail (with a $20 check for one year’s dues) to MAPBD Membership Secretary:
Donna Machniak, 237 Groveland Dr., Howell, MI 48843
Your ideas and comments to MAPBD BOARD:
__________________________________________________________________________________________
| MICHIGAN ASSOCIATION FOR PURE BRED DOGS Web Site: WWW.MAPBD.ORG Application for INDIVIDUAL Membership ANNUAL DUES: $10 |
| MICHIGAN ASSOCIATION FOR PURE BRED DOGS Web Site: WWW.MAPBD.ORG Application for CLUB Membership ANNUAL DUES: $20 |