Name:                                                                                                                                     

Address:                                                                                                                                 

City:                                                                                        State:                ZIP:               

Home Phone:                                           Cell Phone:                                                         

Email:                                                                                                                                      

Occupation:                                                                                                                           

Please check one or more of the following that best describes your interests:

Exhibitor:                                          Breeder:                                 Pet Owner:                   

Show:                                               Obedience:                            Agility:                           

Rally:                                                Therapy work:                       Other:                            

What other dog clubs do you belong to?                                                                            

Should we contact you to help with Match:              Show:                  Rescue:               

or other committees?                                                                                                            

I agree to abide by the laws of the Minuteman Boston Terrier Club and the American Kennel Club.

Signature:                                                                                        Date:                             

Sponsored by:  1.                                                                                                                  

                          2.                                                                                                                   

Dues:         Regular             $20.00           Includes “The Boston Beacon”, voting

                   Associate          $15.00           Includes “The Boston Beacon”, non-voting

                   Family               $25.00           Includes “The Boston Beacon”, adult voting

                   Junior                $12.50           Includes “The Boston Beacon”, non-voting