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. . .Thank you for your interest in joining the Welsh Springer Spaniel Club of America. The Club exists to promote and pro-tect the Welsh Springer Spaniel. The Club has a variety of activities dedicated to this purpose, including a newsletter,breed information and education, national and regional WSS specialty shows, hunting tests, recognition awards and more.The Club expects all members to practice responsible dog breeding, ownership, advertising, sportsmanship, and goodwilltowards our breed as stated in the accompanying Code of Ethics. With these thoughts in mind, please fill out the follow-ing application. Please note that the Club offers a "Subscribing Non -Voting Member" .status that will provide you with thenewsletter, and does not require you to fill out this form. .

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Please type or print legibly. Fill in aU applicable areas completely as they apply to both you and your immediate familymembers. If you need more space your answers may be extended to the" Additional Comments" section on page 3 of thisform. When finished give the application to your sponsor toge"ther with the appropriate membership fee and postage.Your sponsor will then complete the form and forward it to the club. Answers to underlined items are required.

Newsletter Subscription Only - - Non-Voting Member - - (US and Canada) ...oo US . $30

0 Additional Family Members (Same Household) <H"""": "" US $10

0 Overseas Members - - Non-Voting Member - - (Includes OVerseas First Class Mail) US $50

Fees: Make checks (In US Funds) pa able to WSSCA, Inc. t~. . / -Primary Applicant's Name: l.. \A..> ~ e,

Joint/Family Membership -- Additional Names: C '" ~ ~ 'o(! J..

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8. List any other personal names you may have been known by in the past 10 years:

9. Your Business or Occupation(s): \(y);t' - C~\\e~ ~l>\~S5ov' ()~WI\ - \Yr~'->'(o..{lc.e. cJ.(\,)':'j1e.v

10. Check here if you area professional dog: 0 handler, 0 groomer, 0 trainer.

11. Are you an AKC Judge? :""""""""""""""""',""',"':"""""""""""""""""""""","" oo.. 0 Yes.. ~If so, please specify breeds and length of time:

] 2. When did you acquire your first Welsh Springer Spaniel? --5 - '2 b - 03

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. TheWelsh Springer Spaniel Club

of America, Inc.

Membership Application &.Sponsor Endorsement Form

How-many Welsh Springer Spaniels do you currently own? \. .P ease list your dogs' registered names, genders, and breeder of record: "

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Have you or your family owned any other dogs? .: : urY es. . . . . . . . ..0 No

Ifso, whichbreed(S)?' £-0 ~Y,c>\ 'S.~(\~ q. E:,'f <)fo.~ .e\ .Have you exhibited in: . . How Long Titles Earned .

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Obedience: J15S - S 3 c 0Field: , , n., ........

Agility: ........

Other special dog activities:

If any, identify breed(s) and year(s) of whelping:

. If any. list your me~hods of sale/placement of puppies:

. .18. Have you ever soldpuppies to.8 conimers~al out}et or broker? :...: ~. 0 Yes.. Iia"No .

19. . Have you ever left a dog o~ puppies at the pound, shelter, SPCAor equivalent ~ 0 Yes ~.. ooijt'No

.20. Do you plan to breed Welsh Springer Spaniels?w ; 0 Yes ..Iil'"No

21. Have you or a family member ever been suspended by the MC? 0 Yes ..IiJ"'No

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25. "Do you know any WSSCA members? If so, list them and bow long you have known them: ~

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Z6. Why would you like to become a member of the WSScrA? 0"

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26. Why would you like to become a member of the WSS<fA? ."

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27. By my signature below, I certify that I have read, understand, and agree to abide by the Constitution, By-lawsand purposes of the Welsh Springer Spaniel Club of America, Inc., and the roles and regulations oftbe Ameri-can KenneJ Club. I have answered all questions on this application truthfully, in good faith, and to the best of

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Additional Comments

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Please type or print legibly. The Sponsor's Endorsement should only be completed after the Membership Applica-tion portion has been completed by the applicant. Do not complete the Sponsor's Endorsement in advance. Fill inall applicable areas completely as they apply to your knowledge of the applicant and their immediate family mem-bers. When finished, sign, date and send the completed Membership Application/Sponsor's. Endorsement formwith appropriate fees to:

Carla NalewajekWSSCA Corresponding Secretary14 Rudden LnColchester, CT 06415-2808

Mailing Address: '{ 3. 5 9 11-. <: -y fo~ In L R JCity, State, ZIP: '"P.> l?ci S}c.Qd ("J c,- ' :l tf S .;l )Home Phone No: '5 ~. 6 5)'" S- i 0 iE-Mail Address:Ct L>...~\..L~{)"/)G::."C((-.fI. L, (:J, I:. f n...;, rBusiness Phone No:

I. Are you personaJly acquainted with the applicant( s) ~es. . . . . . . . ..0 NoHow long have you known them: .. ~ , c;. 71> 1.

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2. Have you see. where y~u keep their dogs? 0 Yes _..E:rNo

3. Do their dogs appe~ to be ~~ll~adjusted, happy and well. cared for? .. 0 Yes )2I" No

4. Has the applicant previously owned other dogs? ~s O No

If yes, did you iilquire what happened to the other dogs? ~ es. . . . . . . . ..0 No

.. Were you satisfie,d with the an:swer oo~ ~ ~es... 0 No

5. Have you referred the appiicant to loea] owners, trainers, etc.? oo""" J3"'Y es. : . . . . . . ..0 No

6. Has the appHcant e~pressed an interest in becoming a breeder? 0 Yes .~o

Breeding for profit? 0 Yes p No

7. Have you checked over the application? ~ o NoAny additional comments: .

I have reviewed the membership application and discussed it with the applicant. I have discussed genetic health problemssuch as hip dysplasia, epilepsy, and eye diseases with the applicant(s) and they are aware of the various clearances avail-able. I find the responses acceptable and believe that the applicant understands responsible and ethical dog ownership, and

TheWelsh Springer Spaniel Club

of America, Inc.

Sponsor's Endorsement

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