Chattahoochee English Springer Spaniel Club of Greater Atlanta, Inc.

APPLICATION FOR MEMBERSHIP

For Club Use Only:  Date Appl. Rec'd:____________ Dues (amt.) submitted:__________ Check #_______________

Date:__________________ e-mail:____________________________

Name(s):_________________________________________________
Telephone: ___________________________________

Street/Apt. #:_______________________________________________
Work Phone:__________________________________

City:_______________________________ State:______ Zip:________
Kennel Name:_________________________

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What are your primary SPRINGER ACTIVITIES?
__Breeder __Conformation __Obedience __Tracking __Hunting __Field Trialing __Jr. Handling
__Agility  __Prof. Handler __Pet Therapy __Dog Judge [specify]___________
__Other (describe)______________________________
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Are you in good standing with the AKC? Yes __ No __ What is your occupation?__________________________
Do you belong to any other Dog or Breed Clubs? ____________
(optional)____________________________________________
Please List:___________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
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Which COMMITTEES would you prefer to serve on? __Rescue __Show __Match __Ways/Means
__Publicity __Membership __Newsletter __Hospitality __Education _Program __Awards
__Cards/Flowers __Special Events __Breed Referral __Constitution/Bylaws __Judges Selection/Coordination
__Performance Events __Historical Records __Trophy __Public Education __Advertising
__Ga. Coalition of Dog Clubs __Juniors
What SPECIAL SKILLS/TALENTS/INTERESTS do you have that you will share with our club?
__Handling __Grooming __Art/Graphic Design __Writing __Legal _Organizing __Telephoning __Teaching
__Fundraising __Printing __Training (show, hunt, obed., agility) __Computer __Carpentry __Puppy Eval.
__Public Speaking __Public Relations __Mass Media __Photography/Video
__Other: _________________________________________________________________
________________________________________________________________________
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Note: ANNUAL DUES MUST ACCOMPANY THIS APPLICATION.
Please return to.... Zippy Cooper, Membership Chm. If you have a question,call or e-mail
199 Appalachee Church Rd., Zippy Cooper at Auburn, GA 30011 (770) 682-0037 lenlearspringers@mindspring.com
*If you plan to apply for a REGULAR, VOTING membership, you must attend at least one membership meeting before
your application can be processed for approval. Meetings are held monthly on the 4th Thursday, 7:30 pm, always in
the Atlanta area. Call any officer or board member for information.
Policy clarification regarding REGULAR MEMBERSHIP/MEETING ATTENDANCE adopted 1-4-96:

Attendance at a membership meeting may occur before application is submitted; or, after application is submitted, attendance must occur within the time
span of 3 subsequent membership meetings. Applicants will be voted on upon completion of application process. If applicant fails to complete the
membership application process, membership fee is forfeited.

Breeding, Exhibiting, and Activity Records In order that we may get to know you and have a record of your interests and activities,
please complete the following questions.

Applicant’s Name:___________________________________________ Kennel Name_____________________________

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AKC REGISTRABLE DOGS OWNED
What year did you acquire your first English Springer?_________________
Number of English Springers you own or co-own:______________________
Number of other dogs you own:_____ What breed(s)?_______________________________________
Please list the names of your springers:
_________________________________________ _________________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
_________________________________________ _________________________________________
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BREEDING ACTIVITY
Have you bred an AKC registrable litter within the last three years? q Yes q No
If yes, what breed(s)?______________________________
What year did your breeding activity begin? _________________ 
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EXHIBITING ACTIVITY
Indicate types of AKC shows/events and other activities in which you have participated with an English Springer Spaniel in
the last THREE years: 
q All-Breed Conformation Shows q Obedience Trials q Spaniel Hunting Tests
q English Springer Specialty Shows q Tracking Tests q Agility Trials
q Field Trials q Variable Surface Tracking q Other________________ 
What year did your exhibiting activity begin? _________________ 

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OTHER ACTIVITIES
q Hunting q Therapy q Responsible Dog Ownership Education q Hiking/Camping 
q Search and Rescue q Running q Swimming q Retrieving q Sleeping q Traveling
q Flyball q Other___________________________________________________________________________ 

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TITLES EARNED
Titles (AKC, ESSFTA) Earned by dogs you own (last 3 years):
Name of Dog: Title Earned:

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OTHER DOG EXPERIENCES
List (below and on additional paper) other HANDLING, JUDGING, TEACHING, or TRAINING experiences:
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