Join us at club events to meet fellow Labrador owners, learn about training, health, and participate in exciting activities for all ages.

LABRADOR RETRIEVER CLUB OF LONG ISLAND

Full/Junior/Associate Membership, circle one……………………………………………. $25 Annual Dues

Family Membership, same family in the same household………………………………. $35 Annual Dues

The following information is required by the AMERICAN KENNEL CLUB in order for us to apply for AKC 

status.  Please answer all of the questions that are applicable to you completely.

Individual Member

Name: _____________________________________Occupation:____________________________________

Address: _________________________________________________________________________________

City: _____________________________State:_________________Zip:______________________________

Home Phone: ________________________________ Work/Cell Phone: ______________________________

E-Mail Address: ___________________________________________________________________________

Web Site: ________________________________________________________________________________

Additional Family Member (if any) who will also join:

Name: ____________________________________________Relationship: ____________________________

Please list any other dog club memberships below:

Club Name

Offices Held

Dates Held

Kennel Name: __________________________________ Is it registered with AKC? ______________

Do you Exhibit in: (please check)       Are you A: (please check)               Services: (please check)

Breed

Breeder

Boarding

Obedience

Handler/Trainer

Grooming

Field Trials/Hunt Tests

Judge

Stud Service

Tracking

Dog Owner

Puppy Service

Agility

Exhibitor

Please list the following information about each dog you presently own:

Name of Dog

AKC Registration#

Breed/Sex

AKC Titles

Labrador Retriever Club of Long Island                                                                          Application Form –page 2

Specialty Show (please check)                     Match Show (please check)               Other Club Activities (please check)

Advertising

Publicity

Field/Hunting Tests

Publicity

Entry Table

Obedience

Grounds

Show Set Ups

Rescue

Catalog Sales

Mailing Lists

Education

Stewarding

Stewarding

Holiday Party

Trophies

Lunches

Programs

Admissions

Other (please list below)

Hospitality

Other (please list below)

Publicity

Other (please list below)

I/We would be willing to be Chairperson(s) of one of the above: ______________________________________________

I/We would be willing to be on one of the above committees: ________________________________________________

I/We hereby apply for membership in the Labrador Retriever Club of Long Island and agree, if accepted, to comply with the Constitution and by-laws of the Club and the rules of the American Kennel Club.  As a prospective member, I agree that I will not sell or encourage the sale of litters or puppies to wholesale or retail pet outlets.

Individual Member’s Signature:____________________________________________________________________

Additional Family Member’s Signature: _____________________________________________________________

Date: ________________________

PROPOSER:

Name: ____________________________________ Signature:___________________________________________

How long have you known applicant: __________ Association to applicant: ________________________________

Comments: ___________________________________________________________________________________

______________________________________________________________________________________________

SECONDER:

Name: ___________________________________ Signature: ____________________________________________

How long have you known applicant: __________ Association to applicant: _________________________________

Comments: _____________________________________________________________________________________

_______________________________________________________________________________________________

 Return this completed application with the appropriate fee for annual dues to the Secretary of the Labrador Retriever Club of Long Island.  

Secretary:  Michele McGroarty

                   69 Harris St

                   Patchogue, NY  11772