Date: ______________   

Membership Desired:      Single:  $20.00________        Family:  $30.00_______

(If application for membership is made between July 1st and December 31st, the membership fee will be one half of the yearly fee).  

Please make check payable to the VCGNY.

Name: __________________________________Spouse (Other): _______________________________  

Address: _________________________________________________

City: _________________   State: _______      Zip (+4): _______ +  _____

Kennel Name (if any): ____________________________

E-Mail Address: _________________________________   

Home Phone: (______) ____________    Business Phone: (______) __________

Memberships in other dog clubs:

Vizslas now owned, including AKC numbers:


I am interested in:  Show___ Obedience___ Field Trial___Hunting Test___Agility___  

I hereby apply for membership in the Vizsla Club of Greater New York, Inc. and agree to support the Constitution and By-Laws of the
Club and the Constitution, By-Laws and Rules of the AKC.

Applicant’s Signature

Sponsor Member’s Signature

Mail to Membership Chairperson:

Lynn Berezny
7 Nemic Lane
Whippany, NJ 07981