Membership Application – The Midwest Jack Russell Terrier Club

2023 Midwest JRT Club
Membership Application

All memberships run yearly from January 1 to December 31, with membership fees due each year.

Membership Rates – Applying November 1st to last day of February, the following year. Membership expires on December 31st of the membership year.

Single = $25.00
Regular/Family = $40.00
JRT Puppy – Please contact your Midwest JRT Club breede/kennel for details

Click Here to go to Payments Page if you are not immediately redirected upon completion of form.

Application

New Member Renewal JRT Puppy

Referred By

Most recent year you were a Midwest JRT Club member - If more than 5 years, you are considered a new member

JRT Puppy Sponsoring Breeder

Membership

Regular/Family Single Adult

JRTCA Member

Yes No

Primary Member First Name

Primary Member Last Name

2nd Adult Member First Name

2nd Adult Member Last

Family Members

Primary Member Phone

Second Member Phone

Street Address

City

State/Province

Zip/Postal Code

Country

Please read and accept

Persons applying for or renewing a current membership in the Midwest Jack Russell Terrier Club and members of their immediate family shall not be a member of any conflicting organization or any all-breed kennel club. Membership may be terminated, suspended or refused by the Midwest Jack Russell Terrier Club Officers for any conduct which may be considered likely to prejudice or damage the image of or interfere with the efficient running of the Club or compromise the breed standard in any way. I certify that I neither belong to any conflicting Jack Russell Terrier Organization nor do I register my Jack Russell Terriers with any all-breed kennel club.

Electronic Signature

Electronic Signature Date

The Midwest JRT Club publishes an online Member Directory April through September. The directory contains members personal names, emails, postal address, and phone numbers, information that could become publicly available. Members may choose to restrict some information. The names of minor are never included in the Member Directory.

Do Not Publish

Address Primary Telephone 2nd Email 2nd Telephone

I want to help

Contact Me...

Jack Russell Rescue: I Can

Foster a rescue Adopt a rescue Rescue transport

Liability Release

LIABILITY RELEASE: In consideration of my participation as a member of the Midwest Jack Russell Terrier Club (the "Club") at meetings, seminars, play days, fun days, trials and any other such events, I hereby waive any and all claims for and remise and release the Club, its members, officers, directors, and/or any participants from any and all liability for damages to person or property, accidents, or injuries caused by or in any way arising out of or related to participation in any Club activities, including the period of time immediately prior thereto and immediately thereafter the conclusion of the activity. Each signer understands that by participation her or she is a joint venture participant and assumes all risks of liability to themselves occasioned by this participation. The release and waiver shall be effective from the date of signing.

Bulk Email Opt-In

all email addresses only primary email address

Release Opt in:

Payment - Upon submitting form, you will be redirected to the payments page. Membership applications aer not finalized until payment is received..

Check/Money Order PayPal Other

Do you breed JRTCA registered jack Russell Terriers?

Yes No

Welp Date

Do you breed JRTCA registered Jack Russell Terriers?

Yes No

Do you wish to participate in the New Member Puppy program?

Your kennel Name

2023 Midwest JRT ClubMembership Application

2023 Midwest JRT Club
Membership Application