Citrus Capital Pekingese Club
                                                        of Central Florida

                                                 Application for Membership

I hereby make application to become a member of the Citrus Capital
Pekingese Club of Central Florida, an AKC Licenses Specialty Club.

Name:_____________________________________________________

Address:____________________________________________________

City, State, Zip:_______________________________________________

Phone:____________Cell:____________email:______________________

Dou you own Pekingese?:________________________________________

How many do you own at a time?___________________________________

How often do you breed Pekingese?_________________________________

Are you currently showing your Pekingese?___________________________

Are you willing to help on a club committee?___________________________

Which committees would you be interested in serving on?__________________

Do you belong or have you ever been a member of any other specialty

or All Breed Clubs?_____________________________________________

Please list clubs?_______________________________________________

Please include any additional information about yourself or your interests that you

think might be of benefit to the club._________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

I understand that the Citrus Capital Pekingese Club is in existence for the advancement,
protection, and preservation of the Imperial Pekingese and I will continually strive to
uphold this idea.

Signature of Applicant:___________________________________________

Signatures of Sponsoring Members:___________________________________

                                                               ___________________________________

Date:________________________________________________________

Send completed application and $20.00 for dues to:

Morris Payant, CCPC Secretary                Phone: 352 331-5444
115 NW 123rd Street                                   email: moonglowpeke@hotmail.com 
Newberry, FL 32669-3070

President:         Janet Tucker         386 362-7754
Vice President: Zoe Wells               772 340-4314
Treasurer:         Debra Faulkner    863 858-0028
Board of Directors: Brent Brugger, DuaneDoll, Brady Faulkner