Indy Dock Dogs
2622 East 300 South
Greenfield, In 46140
Membership Appication
Owner/handler Information (please print)
Last Name:_____________________First Name:____________________
Mailing Address:______________________________________________
City:___________________________State:________Zip Code_________
Home Phone:_________________Other Phone:_____________________
E-Mail Address:______________________________________________
Additional Family Members:
1._____________________________2.___________________________
3._____________________________4.___________________________
Dog Information:
1.Dog's Call Name_________Breed:__________Date of Birth:______M/F
2.Dog's Call Name:_________Breed:__________Date of Birth:_____M/F
As a member in good standing, I agree to adhere and uphold the By-Laws
of this Club and to promote good sportsmanship while acting as a representative of the Club.
Signature:__________________________________Date:_____________
Payment Information:
Make checks payable to:
Indy Dock Dogs
Return Membership form with payment of dues to:
Indy Dock Dogs
2622 East 300 South
Greenfield, In 46140
