NORTHERN OHIO SCHIPPERKE CLUB

Name: ____________________________________________________________________________

Address:___________________________________________________________________________

City/State/Zip ______________________________________________________________________

Telephone Number: (____)_______________ E-mail:______________________________________

Occupation: ___________________________

Number of years in Schipperkes: _____ Kennel Name: ________________________________

Have you bred Schipperke litters? _____ If so, please list sire and dam of latest litter:
Sire: ______________________________ Dam:_____________________________

What is your interest in the Schipperke breed? _____________________________________________
__________________________________________________________________________________

What would you like the NOSC to accomplish for and through its membership this year? __________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I here by apply for membership in the Northern Ohio Schipperke Club. I agree to abide by the Constitution and By-Laws of the Northern Ohio Schipperke Club and the Rules of the American Kennel Club. I am enclosing payment of dues for the year, ________, in the amount of $______
($20 Single, $25 two or more living at the same address).

Schip Chatter subscription only: $10.00 ______

_____________________ ______
Signature of Applicant .........Date

______________________________________________
Name and Signature of member #1 in Good Standing

______________________________________________
Name and Signature of member #2 in Good Standing

Return with payment to:
Cynthia Lewis, NOSC Treasurer
6563 Lincoln Rd.
Wakeman, OH 44889
(216) 839-55159