POTOMAC HOUND CLUB (PHC) 
Membership Application 


Dear Prospective Member: Please review our club’s Constitution and Bylaws before 
completing this application. Then provide the information requested below regarding your 
dog ownership and breeding records. If your activity is extensive, you may either provide a 
random sampling or include details on a separate page. Our bylaws require that you must 
be sponsored by two PHC members who are in good standing and from two separate 
households. Fill out and sign your application then obtain the signatures of your sponsors, 
and mail it along with a check for your dues ($35.00 per person per year or $50.00 per 
family/household per year) to: 

Annie L. Andrews 

Secretary, Potomac Hound Club 

6019 Crupper Place 

Fairfax, VA 22030 
After your application has been received, your information will be published in the next 
PHC Newsletter. PHC members may provide a written input to the PHC Board regarding 
your application within thirty (30 days) of the Newsletter. The Board will then vote on your 
membership at the next Board meeting, and a two-thirds majority is necessary for election 
as a member. If denied, you may re-apply after six months. (PHC By-laws Article II, Section 
3 Election to Membership). If approved, you will be notified via email followed by an official 
welcome letter, a copy of the Club’s Constitution and By-laws, the current Club 
Membership Roster, and a PHC pin. 

Name:______________________________________________Occupation:_________________________ 
Address:_________________________________________________________________________________ 
Phone Number(s):________________________________________________________________________ 
Email Address:_____________________________________________FAX Number:________________ 
Breed:___________________________________Years in the Sport of Purebred Dogs:____________ 
Interest(s):_______________________________________________________________________________ 
Current Activity in Dogs (e.g., breeder, exhibitor, handler, judge):__________________________ 

List other dog clubs (including parent clubs) in which you are/were a member, the dates, 
and offices/positions held: 

Briefly describe your activities and accomplishments in the sport of purebred dogs: 


PHC MEMBERSHIP APPLICATION (PAGE 2) 

Average Number of Dog Shows Attended Each Year:_______________________________________ 
Total Number of Litters Bred:_____________Total Number of Champions Bred:______________ 
Total Number of Champions Finished:_______ Current Number of Dogs Owned:____________ 
Dogs Owned: 

Breed Name AKC # 

Litters Bred: 

Breed Date Whelped Litter # 

Shows Attended: 

Show/Date Show/Date 
Show/Date Show/Date 
Show/Date Show/Date 
Show/Date Show/Date 
Show/Date Show/Date 

SPONSORS 

SPONSOR #1:___________________________SIGNATURE:_________________________DATE:________ 

(PRINTED NAME) 
SPONSOR #1:___________________________SIGNATURE:_________________________DATE:________ 

(PRINTED NAME) 

I submit my application to the PHC and, if approved, will abide by the PHC Constitution and By-laws. 
SIGNATURE:_____________________________________________DATE:_________________________