AHTA - Membership Application

Membership Application
(New Members)

If you are an existing member - please use the Renewal Form

Single membership:________ (enclose $15.00)
Family membership:________(enclose $20.00)
Honorary membership:________ (Non-voting, enclose $10.00 by money order)

Name:____________________________________ Phone:________________________

Family members (if family membership):__________________________________________

________________________________________________________________________

Address:_________________________________________________________________

E-mail address (if applicable):________________________

Do you own an American Hairless Terrier? ________ If so, how many? ________

Names of dogs:___________________________________________________________

Are you a pet owner? ________ or breeder? ________ Kennel name?________________

If you do not own an American Hairless Terrier, do you plan to one day? ________

Tell a little about yourself and why you want to be a member: _________________________________________________________________________

_________________________________________________________________________

Do you know anyone that is a member of the AHTA? ___ If so, who?__________________

I have read and signed the AHTA Code of Ethics and have enclosed a signed copy to be placed on file with the AHTA. I have also enclosed my annual membership dues of $_____ along with this membership form. Please accept my name for consideration in The American Hairless Terrier Association.

Signature: ________________________________ Date: ________

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Make checks payable to: American Hairless Terrier Association

Send application with payment to:

American Hairless Terrier Association
c/o Melissa Kidd
4509 Pete Lane
Trinity, NC 27370