MASTIFFF CLUB OF FLORIDA MEMBERSHIP APPLICATION PO BOX 220026 Glenwood, FL. 32722

HOSEHOLD MEMBERSHIP ( ) SINGLE MEMBERSHIP ( ) JUNIOR MEMERBSHIP ( ) CHARTER ( )

LIFETIME ( )

SECTION I APPLICANT:

LAST NAME ___________________________FIRST NAME_______________________________

PHONE: _________________________ E-MAIL:___________________________________

MAILING ADDRESS: ____________________________________

CITY: _____________________________ STATE: ___________ ZIP CODE: __________________

DOB: __________________________

OCCUPATION: ___________________________________________________________________

SECTION II FILL IN THIS SECTION FOR HOUSEHOLD MEMBERSHIP ONLY SPOUSE_______________________________OTHER____________________________________

PHONE: __________________________E-MAIL: _______________________________________

DOB: _________________________________

OCUPPATION: ____________________________________________________________________ CHILDREN:

NAME: ________________________________DOB: ______________________________________

NAME: ________________________________DOB: ______________________________________

NAME: ________________________________DOB: ______________________________________

NAME: ________________________________DOB: ______________________________________

NAME: ________________________________DOB: ______________________________________

SECTION III MASTIFFS IN HOUSEHOLD: _________________________________________________________

LIST OTHER BREEDS IN HOUSEHOLD: _______________________________________________

SECTION IV PLEASE INDICATE YOUR AREA OF INTEREST: OBEDIENCE ( ) CONFORMATION ( ) THERAPY ( ) BREEDER ( )

ARE YOU AN MCOA Member? Yes ( ) No ( ) PENDING ( )

SECTION V MCOF ENCOURAGES ALL MEMBERS TO BE ACTIVE AND ATTEND QUARTERLY MEETINGS WHEN POSSIBLE. PLEASE CHECK ALL AREAS YOU MAY WANT TO LEARN MORE ABOUT BEING A PART OF: MEMBERSHIP ( ) TRAINING ( ) RESCUE ( ) EVENTS ( ) MARKETING ( ) WEBMASTER ( ) V.A. PROGRAM ( ) AT RISK KIDS PROGRAM ( ) EDUCATION ( ) FUND RAISING ( ) NEWSLETTER ( ) LEGISLATION ( ) ETHICS ( )

LIST OTHER: _______________________________________________________________________

I HAVE READ AND UNDERSTAND THE ELIGIBILTY REQUIREMENTS OF THE MASTIFF CLUB OF FLORIDA AND AGREE TO THE WAIVER & RISK AGREEMENTAND THE CODE OF ETHICS AND AGREE TO ABIDE BY THEM AS CONDITIONS OF MEMBERSHIP. SIGNATURE OF APPLICANT(S) ________________________________________________

DATE ________________________________________________________________________