Membership Renewal Form – Badger Kennel Club

Membership Type: *

Individual Member (0-19 hrs) – $80
Individual Member (20-59 hrs) – $60
Individual Member (60+ hrs) – $30
Junior Member – $20.00
Household Membership (0-34 hrs) – $120
Household Membership (35-84 hrs) – $100
Household Membership (85+ hrs) – $50
Lifetime Membership – $0

Check your membership level and provide the volunteer hours you contributed to BKC while you were a member in the past year. Your renewal is not complete until you have provided this information and paid your dues.

Name *

Kennel Name *

Address *

City, State, Zip *

Home Number *

Cell Phone *

Email *

Occupation (If retired, list former) *

Membership Breed and Services Referral Directory Listing *

Yes
No

If you are interested in being listed include $15, AND contact Laura Hesse at bkc-lmhesse@charter.net

Activities /Committees you would like to serve on:

Other Activities/Committee explanation:

By Signing Below, I agree to the following: *

I Agree

1. I understand that attendance at BKC functions is not without risk to myself, members of my family, guests or my dog because some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I hereby waive and release BKC, its contractors, officers, members and agents from any and all liability of any nature, for injury or damage which my dog(s) or I may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any BKC activity/event or while on the training grounds or the area surrounding it. In consideration of and as inducement to the acceptance of my membership renewal in BKC, I hereby agree to indemnify and hold harmless BKC, its contractors, officers, members and agents from any and all claims by any member of my family or any other person accompanying me to any BKC activity/event, or while on the training grounds or the area surrounding it as a result of any action by any dog(s) including my own.

2. Commitment to BKC’s Code of Ethics as stated in BKC’s Policy and Procedures Manual and as posted on BKC’s web site.

3. Notification by e-mail of club and board meetings, dues notices, minutes, newsletters, etc. This authorization, which is revocable, releases BKC from any and all liability should the notification be received late or not received by me due to circumstances beyond BKC’s control.

Electronic submission of this form constitutes acceptance of all terms and conditions set forth herein.

How will you pay for the application fee? *

Paypal
Check

If paying by check, submit this form, make a check out to Badger Kennel Club and mail your check to the treasurer:

Joan Parrish (Secretary)
2046 E Blue Mounds Rd
Mt Horeb WI 53572

Total amount to be paid:

Include your membership dues and any additional fees, including key fee and breed directory listing fee.

Signature *

Typing your name above serves as your legal signature.

Signature (2nd Household Member)

Typing your name above serves as your legal signature.