NAME___________________________________________________________
ADDRESS_________________________________________________________
   _________________________________________________________
PHONE___________________________________________________________
EMAIL___________________________________________________________


List dogs you own now:
BreedRegistered Name
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Please list any other clubs you are involved with: ____________________________________________


Areas of interest: Conformation/Show_____ Obedience_____ Agility_____ Hunting_____Other_____

Areas in which you would like to help or participate, please check all that apply:

Specialty and Show Assistance___ Awards___ Fund Raising___
Trophy Fund___ Breed Education/Breeder Referral___ English Setter Rescue___ Other___

Do you agree to abide by AKC rules? __________
Do you agree to abide by the KMESC Constitution? ________


Signature___________________________________________ Date_______________

Sponsors___________________________________________

              ___________________________________________


Return application and check payable to “KMESC” to Membership Chairman:
Jane Rapant  N6658 County Hwy F., Oconomowoc, WI 53066  

Dues:   $20 - Single
   $25 - Family
   $10 - Junior
Date Rec’d_______________                                               Date Read_______________

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