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The Spirit of St. Louis Samoyed Club

The Spirit of St. Louis Samoyed Club-a diverse group of people participating in agility, conformation, obedience, rescue, herding, hiking, sledding, therapy, parades, Temperament Testing and the Safety Sam Dog Bite Prevention Program among many other activities. We are bound together by our love and respect for our Samoyed dogs.

Application
Below is an online application form for the Spirit of St. Louis Samoyed Club.  Yearly dues are as follows:
Individual- $10     Family (2 adults)- $17.50     Junior (under 18)- $5
Your dues include an annual subscription to our quarterly newsletter.

Please make sure EVERY box labeled with an asterick (*) is filled in.  When you have completed the form, click the SUBMIT button at the bottom of the form and your application will be automatically forwarded to us.
Spirit of St. Louis Samoyed Club-Application Form
Fill in all fields marked with an asterisk (*)

 

First Name:*
Last Name:*
Address Street 1:*
Address Street 2:
City:*
Zip Code:* (5 digits)
State:*
Daytime Phone:* (1234567890)
Evening Phone:* (1234567890)
Email:*
Samoyeds Owned- Total:*
----Boys:*
----Girls:*
Dogs owned OTHER than Sams- Total:*
List Other Breeds:*
MEMBERSHIPS:*   Are you a member in good standing with any of the following?  (check all that apply): None AKC SCA IKC UKC Breed Club Other (list):  
EVENTS:*            Have  you ever participated, coached and/or judged any of the following? (check all that apply)  None Agility Conformation Coursing Herding Obedience Sledding Tracking
Other (describe): 
Judges:*
Are you or any member of your immediate family a licensed judge?
No Yes
---If Yes, list Events-*
---If Yes, which associations?*
INTERESTS:*          What activities are you interested in? (check all that apply): None Agility Breeding Conformation Coursing Education Herding Obedience Sledding/Carting Tracking  
Other Interests (list details):
Talents:*             Do you have any special talents/expertise/interest that might benefit the club or its activities (i.e web design, artwork, dog training, fund raising, etc)?  If yes, please describe: 
Sanctions:*  Have you ever been sanctioned and/or had other disciplinary action taken by AKC, SCA, or any other governing body (including any local, state, or federal governmental agency) for any animal related reason?  If YES, please describe:
Comments:

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