Dog Hobbyist Club Membership Application

Please fill in this form in its entirety, failing to do so will may result in your application for membership being delayed or denied.
First AND Last Name : 
Kennel / Business Name : 
Address : 
City : 
State : 
Zip Code : 
Home Phone Number:
(with area code) 
Cell Phone Number :
(with area code) 
Email Address: 
Website URL : 
What breeds do you own / raise : 
How many of each : 
Select a username:
Select a password:
I was referred to the club by:
Include my contact information and website in the online Directory?
I have READ and AGREE to the Dog Hobbyist Club Membership Agreement, if you do not agree with the terms stated, do not join as your application will be denied.

For added security your IP address: 38.107.179.220 has been recorded.

If you prefer to send your application in by mail, please use the "Print" button below.

Signature of Applicant: _____________________________________________

Print, Sign, and Mail your completed application with the $20 annual membership fee to:
Jean Flowers - PO Box 153 - Abie, NE 68001
Print using the below button instead of your web browser print button for better printing quality.