Name(s):        

Address: 

City,  Prov.
                
Postal Code:                                                           Phone No.

Email Address:
CKC Membership No.

Breeders Only
Kennel Name:       Tattoo Combination
Do you want to be on the Breeder's Referral List? yes No
Please check what information you want listed.    Phone #    Email Address  Website
 web address 

Membership Type Single Associate $25 Single Voting $30 Joint Associate $35 Joint Voting $45   Dues received after March 31 is subject to a $5.00 surcharge

Donations
 Trophy Fund National Martimes Quebec Ontario Prairie B.C.      Amount:        Rescue Martime Quebec Ontario Prairie B.C.     Amount               

Other:      Yearbook        Best Liitle Pal Fund:        Health Research Fund:            Total Amount