IFCBE Breeder/Exhibitor (Voting) Charter Membership Application
Print this page, then sent it and your dues to:
IFCBE, c/o Laura Morgan, 212 Overlook Road, Ithaca, NY 14850.
Name:
E-mail Address:
Mailing Address:


City, State, Zip Code:
Are you over 18 years of age? (circle one of the following) YES / NO
Do you own or co-own a U.K.C. registered Chinook? (circle one of the following) YES / NO
List the two Board Members who are sponsoring you:

Circle areas of interest to you.(Optional)
  • Agility
  • Conformation
  • Carting
  • Flyball
  • Herding
  • Obedience
  • Packing
  • Search and Rescue

  • Skijoring
  • Sledding
  • Therapy
  • Tracking
  • Weight Pull
  • Other (please state activity)
    • Circle, from the following list, the amount you are enclosing and the length of membership for which you are applying. Please note: Once you have paid these fees they are not refundable. You will receive a $5.00 discount for each year you join in addition to year one.
  • $100.00 - Initiation fee and Year 1
  • $135.00 - Initiation fee and Years 1 and 2 ($5 savings)
  • $160.00 - Initiation fee and Years 1, 2 and 3 ($10 savings)
  • $175.00 - Initiation fee and Years 1, 2, 3 and 4 ($15 savings)
    By signing this application, I certify the above information is accurate and complete.

    Signature:

    • copyright IFCBE, 2000 - 2004
    Form current January 9, 2004