Please check one:  Single ($10): ____ Family ($15): ____

Name: ______________________________ Spouse: _____________________________

Children: ________________________________________________________________

Address: ________________________________________________________________

Telephone: ___________________ E-Mail: _____________________________________

Please Fill out if you would like added to club web site.

Kennel Name___________________________

Kennel Web site__________________________

How many APBT’s do you own? _______

Conformation Shows______  Fun Classes______  Both_______

I understand and agree as a member of  AADR Tar heel APBT Club our main

purpose is to promote a positive image of the APBT through conformation

and Fun Classes. I understand the AADR Tarheel Club will not tollerate any illegal behavior.  I understand  and agree my  membership can be revoked

at anytime for failure to comply with this organization’s rules ..

Signature: ____________________________________ Date: ____________________________

Please return this along with membership fees

(made out to Billie Jo Shirley-Tar heel APBT Club) to:

350 East Littlefield Road Ayden, North Carolina 28513.

___________________________________________________________________:

Date Application Accepted: _________________ Dues Paid: __________________

Date Membership Card Issued: _______________