Name: ______________________________________________________________________________________________

Children: ____________________________________________________________________________________________

Address: ____________________________________________________________________________________________

Telephone: _____________________________ Email: _______________________________________

How many APBT'S do you own? _____ How long have you been involved with this Breed?___________

Has legal action ever been taking against you as a result of your dog's behavior? ___Yes ___ No

If yes, please explain (write on back if necessary) :

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Please check all that apply. I am interested in the following activities:

I understand and agree as a member of The American Pit Bull Terrier Association our main purpose is to promote a positive image of the APBT through conformation and weight pull shows. I agree I am not joining the group in the hopes of seeking illegal activities to partake in and understand this behavior will NOT be tolerated by this club. I hereby agree to abide by the Constitution and By-Laws of this organization and all rules set forth by the ADBA. I understand my membership can be revoked at anytime for failure to comply with this organization's rules and purpose.

Signature: _________________________________________________________________________ Date: _____________

Please return this along with your membership fees to ( address listed above.)