Please use the form below to submit your membership application.

Online Member Access – Once your membership is approved, you will get an email with a link to set up your online account and Member Directory listing.

If you have any issues, use the Contact Us form.

Membership Application

Date*

Name* Address*

City*

State*

ZIP Code*

Phone*

Alternate Phone

Email*

Alternate Email

Occupation* Sponsor's Name** ** If you are applying as an associate member (non-voting), you are not required to have a sponsor. If you are applying for an individual or joint membership (voting) you must be sponsored by a current club member, in good standing. See membership categories for more information. Other Club Affiliations Have you ever been suspended by the AKC?* YesNo

If so, when? Reason for suspension*

Are you a breeder? YesNo

How many litters do you produce annually? How do you sell your puppies?

Please tell us the reason(s) you would like to become a member and how you heard about us:* Have you recently adopted a dog from SCWTCGTB Rescue Program? YesNo

Date of adoption:*

Name of Pet:*

------------------- I agree to comply with the Constitution and By-Laws of the Soft Coated Wheaten Terrier Club of Greater Tampa Bay and the Rules of the AKC. I (We) have read and will abide by the Code of Ethics as read on our website (flwheatenclub-org.preview-domain.com). I (we) understand that our application for membership will be reviewed and published on the SCWTCGTB website as part of the approval process. Signature of Applicant (type your full name)* Signature of Co-Applicant (type your full name) Signature of Sponsor (for voting membership)

Date of Signatures*

------------------- Is this membership for one or two people? One PersonTwo People Membership Category Applied for: (indicate one category) Associate (non-voting)

Associate-Individual

Associate-Joint

Voting Member

Voting-IndividualVoting-Junior

Voting-Joint

------------------- Associate - 1 person, or 2 residing at the same address. Holds all the privileges of full membership except are non-voting memberships and are not required to have a membership sponsor. Associate members are not counted for quorum for voting purposes. If you rescue a Wheaten from our Rescue program, the remainder of the current year is free as an Associate member. Individual - full voting membership reserved for individual planning to attend most meetings of the club & be counted for quorum. Board members, rescue, co-chairs, and people listed as a breeder on our website must be voting members). Requires a club member sponsor. Joint - 2 persons residing at same address. Full voting membership reserved for individuals planning to attend most meetings of the club & be counted for quorum. Board members, rescue, co-chairs, and people listed as a breeder on our website must be voting members). Requires a club member sponsor. Junior - non-voting, non-dues paying membership. Open to individuals under 18 years of age. Honorary - non-voting, non-dues paying membership bestowed on select individuals with long standing service to the club. ------------------- DUES: $25 one person/ $35 two persons residing at the same address. Applies to Individual, Joint and Associate memberships. Send no money now. Dues will be payable upon notice that membership has been accepted. ------------------- Additional Comments or Questions (optional)

Membership Application

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