Name(s): __________________________________________ Date: ____________________
Address: ____________________________________________________________________
City: ___________________________________________________ State: ___ Zip: ________
Home Phone: (____)_________________
Cell Phone:_______________________
 E-Mail Address: ______________________________________________________________
Kennel Name: _______________________ Website: _________________________________
Tell us a bit about yourself
What made you decide to get a beardie? ____________________________________________________________________________
I am a: Family Dog Owner: ___ Exhibitor: ___ Breeder: ___ Judge: ___ Handler: ___
Total Number of dogs: ____ Beardies: ____ Honorary Beardies: ____
Other pets: ____   Type: ________________________________________________________________________________________
Dog related Interests:___________________________________________________________________________________________
Other areas of expertise: ________________________________________________________________________________________

Areas of interest
Event Planning ___ Conformation ___ Obedience ___ Agility ___ Herding ___ Therapy Cert. ___ Newsletter ___ Show Committee ___ Judging ___ Photos ___ Fund Raising ___ Social Events ___ Public Ed. _____ Other (Please describe)___________________________________________________________
Membership Type: Individual ($30.00): ______ Household ($40.00): ______
Dues payable for the current fiscal year ______________ are enclosed with this completed application.
Please make check payable to CBCC and mail to:
Deb Figura /  9520 Champion Court / Spring Grove / IL  60081
Questions? Email
I acknowledge that I have read the Chicagoland Bearded Collie Club By-laws and Club policies.
Applicant Signature: ______________________________________________________________________ Date: ______________

Sponsor's Name and Signature: _____________________________________________________________ Date: ______________
For CBCC Use Only: Date Presented: ____________ Date Voted: ______________ Yes _____ No_____ Member Type: ___________ Check #: _______ Amount: _____
Electronic Communications Authorization on File: ______
I hereby authorize The Chicagoland Bearded Collie Club to send any notifications (including but not limited to dues notices, agendas, minutes and newsletters) through the use of E-mail or other electronic means. This authorization releases the club from any liability should the notification be received late or not received due to circumstances beyond the club’s control. It is my responsibility to maintain an updated email address with Chicagoland Bearded Collie Club.  I acknowledge that if I elect not to authorize the Club to provide communications by E-mail or other electronic means, the Club shall have the authority to charge me a reasonable fee for costs incurred in mailing such communications to me.

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