Wirehaired Club of America (WVCA) Parent Club - Application Form for 2021 Membership Period: one year from January – December. Send completed application form and payment to: Wirehaired Vizsla Club of America, 8377 State Highway 78, Kewanee, IL 61443-8756 Make checks payable to Wirehaired Vizsla Club of America OR use PayPal: [email protected] Single ($35) ☐ Family ($50) ☐ International (Non-Voting) ($25) ☐ Associate ($20) ( Non voting) Junior (FREE) ☐ (under 18 years of age)

Mr. ☐ Ms ☐ Mrs. ☐ Last Name: ______First Name: ______

Mr. ☐ Ms ☐ Mrs. ☐ Last Name: ______First Name: ______

Street Address: ______Apartment/Unit: ______

City: ______State: ______Zip: ______

Home Telephone (Required): (____) ______- ______Mobile Telephone (Optional): (_____) ______- ______

Occupation (Optional): ______

E-mail Address: (Required)______Your e-mail address is required in order to receive updates on WVCA events.

Facebook Name (Optional)(for WVCA Facebook page): ______

The club may post members’ names, addresses, e-mails, and phone numbers on a password protected, members only club website. Check if you DO NOT want your e-mail address posted: ☐ Check if you DO NOT want your phone number posted: ☐

Please indicate information about any of the Wirehaired Vizsla(s) you own AKC or Foreign Call Name Sex D.O.B. Registered Name Registration #

What are your -related interests?

Hunting ☐ Field Trial ☐ Hunt Testing ☐ Obedience ☐ Agility ☐ Tracking ☐ Dock Diving ☐ Conformation ☐ ☐ Other (Please Describe): ______I am currently the following:

Judge ☐ Exhibitor ☐ Breeder ☐ Kennel Name: ______

New to breed and want to learn more about: ______

Are you interested/considering breeding in the future? ☐ Yes ☐ No

Please check those items in which you are willing to help.

Hunt Tests ☐ Conformation Shows ☐ Performance Events ☐ Web site ☐ Newsletter ☐ Social Events ☐ Board of Directors ☐ Club Relations ☐ Mentoring ☐ Rescue ☐ Other (Please list Special Skills) ☐ ______

Other Clubs List current memberships in other (AKC) Parent or Local Breed Clubs, Foreign Dog Clubs or Other (Hunt, Obedience, Agility, etc.): ______

Other information Have you ever been denied membership or been suspended by the American Kennel Club (AKC) or an AKC recognized Breed or All Breed Club? (If yes, please explain below or on separate statement)

______

Rules for Applying for Membership * Send your completed application form and payment to: Wirehaired Vizsla Club of America, 8377 State Highway 78, Kewanee, IL 61443-8756. Please make checks payable to Wirehaired Vizsla Club of America or WVCA. * The membership Period is for one year, from January – December. Dues shall be payable on or before the first of January of each year. On March first an individual or family must re-apply for membership and submission to the board for consideration For applications accepted October 1st thru December 31st, their membership and dues will be credited for the ensuing calendar year. * No member may vote whose dues are not paid for the current year.

Assumption of Risk and Liability Waiver Some WVCA events by their very nature are inherently dangerous and involve some degree of risk. I am aware that participating in the Wirehaired Vizsla Club of America’s events may expose me to certain risks and dangers including, but not limited to the hazards of mountainous, aquatic, or wilderness terrain, accident, illness, the forces of nature, and travel to and from the trailhead or point of departure. I am aware that it is not possible to foresee all of the potential hazards of WVCA activities. Each participant in a WVCA activity is responsible for his or her decisions.

To the best of my knowledge, I feel physically and mentally able to assume full participation in the outings of activities in which I will participate. I understand that the Wirehaired Vizsla Club of America is a volunteer organization. In consideration of voluntarily participating in these events or activities, I have and do hereby assume all the risks inherent in these activities and hold harmless the Wirehaired Vizsla Club of America and its agents, tour leaders, officers, and instructors, from and against any and all claims, liability, and demands of any nature, for the acts or omissions of the Wirehaired Vizsla Club of America or its agents, leaders, officers, or instructors. I understand that the Wirehaired Vizsla Club of America (WVCA) is an American Kennel Club (AKC) affiliated club and by submitting my membership application to the WVCA, I agree to adhere to the WVCA Constitution, By-Laws and Code of Ethics as well as the AKC’s Mission Statement. I have read the WVCA Constitution, By-Laws, Code of Ethics and the AKC’s Mission Statement and agree to abide by them. I HAVE READ AND UNDERSTAND THE ABOVE STATEMENTS CONCERNING THE WVCA.

Each member and each household member must sign the WVCA Liability Waiver. A parent or guardian must sign the form with members under 18 years of age.

Signature: ______Date: ______

Signature: ______Date: ______

Signature: ______Date: ______(Parent/Guardian)