I hereby apply for membership/renewal to the Great North Epagneul Breton Gun Dog Club.

Name:__________________________________ Phone:_______________________________

Family Members:________________________________________________________________

Address:_________________________________ Email:______________________________

City, State, Zip:__________________________________________________

Enclosed is $20.00 single or $30 family for membership dues in the Great North Epagneul Breton Gun Dog Club. I affirm that I am eligible for membership under the club bylaws and agree to abide by all rules and regulations of the club and the United Kennel Club insofar as the club’s activities/events are concerned.　

Date:___________________ Signature:__________________________________

President: Steve Broughton

Vice President: Anne Johnson

Secretary: Cristin Broughton

Treasurer: Keith Beseke

Corresponding officer: Russell Winter

We may publish and distribute to our membership a directory of member’s names and addresses. Would you like to be included in the directory? _______Yes ______No

I currently own ______ Epagneul Bretons.

Is your dog registered with the UKC? ____Yes ___No If yes registration #_________________

Do you hunt your dog? ____Yes ____No

Do you breed Epagneul Bretons? ____ Yes ___No

I would be interested in volunteering for: ____ Field events ____Show events ____Committees ____ other:___________________

I would like to see the club sponsor the following events and /or activities: ________________________________________________________________________

Make all checks payable and send to:

Great North Epagneul Breton Gun Dog Club, C/O Keith Beseke 25560 130^th Ave. Welch, MN 55089