NAME: _____________________________________________________________________________ ADDRESS: __________________________________________________________________________ CITY: _____________________ STATE: ____________ ZIP: __________________________________ COUNTRY: __________________________________________________________________________ Telephone/Fax/Internet Information HOME PHONE: ______________________________________________________________________ CELL PHONE: _______________________________________________________________________ BUSINESS PHONE: ___________________________________________________________________ FAX NUMBER: _______________________________________________________________________ EMAIL ADDRESS: ____________________________________________________________________ WEBSITE NAME: _____________________________________________________________________ WEBSITE ADDRESS: __________________________________________________________________ Type of Membership Requested.....Make Checks payable to AHTCA NEW/Renewal: $20.00 (yearly) Junior Membership: $10.00 (yearly) Address Change: $10.00 Breeder Referral Listing: $25.00 (yearly) Please check: Payment enclosed ( ) Payment submitted On Line ( ) Don't forget to print and sign a copy of the AHTCA Code of Ethics to enclose with this form. I hereby apply for membership in the American Hunt Terrier Club Association. I agree to abide by the objectives and purposes stated in the AHTCA Constitution and By Laws. Sign: _________________________________________ Date: _____________________________ Home of the Hunt Terrier also known as the Black and Tan Jack Russell |
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