FOX TERRIER
NETWORK
Membership Application

NAME:  __________________________________________________________________

ADDRESS:  _______________________________________________________________

CITY: _________________________________ STATE: ________ ZIP:  ____________

Day Phone_____________  Evening Phone_________________  Email________________

Age:  18-29___ 30-39___ 40-49___ 50-59___ 60-69___ 70-79___ 80+____

Occupation:  ___________________________  Spouses Occupation: __________________

What breeds do you own, how many and how long?

Wire Fox Terrier_____ Smooth Fox Terrier_____ Other______

Dogs names and date of birth (month/day/year): ______________________________________

How did you learn about FTN?  Friend/Family_____ Google search_____ Yahoo search_____ 
FTN Brochure_____ Dog Fancy Ad_____ Dog World Ad_____ 
Other(please specify)____________________

I am active in:

Obedience ____ Earthdog ____ Agility ____ Rescue ____ Pet Therapy ____ 
Couch Potato ____ Conformation Shows_____ Breeding______

I'd like to help with:

Newsletter_________  Fundraising__________  Education Comm. __________  
Membership Comm. _________

What other dog organizations do you belong to?_________________________________

What special talents and background do you have that might help FTN with its work in 
helping Fox Terriers and their owners?______________________________________________

____________________________________________________________________________________

Annual dues for FTN are $20.00 for a single, $25.00 for a married couple 
 $30.00 for anyone outside of the continental U.S.    
Our annual year is from April 1st to March 31st - Dues are due on April 1st of each 
year.

SIGNATURE___________________________________________DATE____________

Return to:
Phyllis Nash
Fox Terrier Network
1237 Monte Vista Dr.
Riverside, CA 92507