Name                                                                                    
Address                                                                                 
City                             State                            Zip                  
Home Phone                         
Work Phone                          
Email Address                           
Breed(s) owned                      
Are you a member of another dog club?
If yes, please list below:
                                                                                             

Years tracking:                            
Titles earned:
TD     TDX      VST   
Other titles your dogs have earned:
                                                                                             

Are you a judge?
TD      TDX      VST      Other                    

Class of membership
Individual      Family      Junior    

I hereby apply for membership in the Moraine Tracking Club and agree to abide by the Constitution, By-Laws and regulations of the club. I further agree to assume full responsibility and liability of my dog or dogs, myself and members of my family while engaged in club activities or on any premises, grounds or other places under the club's sponsorship or control. I hereby release the Moraine Tracking Club from any and all claims, actions, or causes of actions, growing out of or arising from or in connection with any and all said club activities and any premises or places under its control.

Moraine Tracking Club, Ltd.
219 Beaumont Lane
Barrington, IL 60010