Make copies of this application.
PLEASE PRINT/TYPE ALL INFORMATION CLEARLY
 

YTCA Members Name__________________________________________
 

Address ______________________________________________________
 

City ____________________________________ State_______ Zip________
 

Telephone________________________


email: ____________________________________
 

Date voted into membership: _________________________________
 

Breeder of Applicant: _______________________________________

Owner of Applicant: _________________________________________
 

AKC registered name and number of merit award applicant:
 

Name _____________________________No.____________________ Sex ______
 

Date title earned: _________________________________
 

Attach proof of title (either copy of AKC award magazine page in which the title was
recorded or a copy of AKC title certificate along with copy of the Registration Certification
[white slip]). If original documents are sent, you must provide a stamped self-addressed
envelope to have them returned.
 

New member will have one (1) year from the date of acceptance into the club to apply for
merit award status of their dogs.
 

Send application to: Vivian McKinley
1421 S. Ocean Blvd. # 422
Pompano Beach, FL 33062-7314
 

I certify that this application and enclosed material is true and correct to the
best of my knowledge and belief.
 

YTCA Members Signature _____________________Date______ 20____
 

Application verified by_________________________Date______20____