NTCA Membership Application Form

Membership Application

1Applicant Information

2NTCA Membership Application

3NTCA Code of Ethics

4Electronic Communications and Postal Fee

5Membership Application Signature

6Comments

7Payment

What Membership Type are You Applying For?*
- Individual Membership
- Dual Membership
- Associate Membership
- Junior Membership
Applicant Name*
First Last
Dual Applicant Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Dual Applicant Phone Number
Alternate Phone
Email Address*
Dual Applicant Email Address
Occupation (if retired, please list former occupation)*
Dual Applicant Occupation (if retired, please list former occupation)*
Date of Birth*
MM slash DD slash YYYY
Sponsor 1 Name*
First Last
Sponsors must be individual or dual members of the NTCA and personally well-acquainted with the applicant for a continuous period of 24 months for individual, dual, and junior membership applicants or 6 months for associate membership applicants. International members may only sponsor International applicants.
Sponsor 2 Name*
First Last
Sponsors must be individual or dual members of the NTCA and personally well-acquainted with the applicant for a continuous period of 24 months for individual, dual, and junior membership applicants or 6 months for associate membership applicants. International members may only sponsor International applicants.
Have you applied for NTCA membership in the past?*
- Yes
- No
When did you apply for NTCA membership in the past?*

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The NTCA Code of Ethics can be viewed and downloaded HERE. Please read and review it carefully.
By signing this Code of Ethics, I acknowledge that I understand and agree with the purpose of the Norwich Terrier Club of America and that I will do my best to promote the best interests of the Club and the Norwich terrier. Furthermore, I will conduct myself in a manner of good sportsmanship at conformation, companion and performance events, so as to reflect positively on the sport of purebred dogs. I understand that violation of this Code of Ethics can subject me to the disciplinary process provided by the NTCA Constitution and Bylaws.
By signing this Code of Ethics, we acknowledge that we understand and agree with the purpose of the Norwich Terrier Club of America and that we will do our best to promote the best interests of the Club and the Norwich terrier. Furthermore, we will conduct ourselves in a manner of good sportsmanship at conformation, companion and performance events, so as to reflect positively on the sport of purebred dogs. We understand that violation of this Code of Ethics can subject us to the disciplinary process provided by the NTCA Constitution and Bylaws.
Junior applicants (10-17 years of age) shall agree to abide by the NTCA Code of Ethics, but do not need to return a signed copy of the NTCA Code of Ethics with their application.
Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Applicant Signature*
Dual Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Dual Applicant Signature*

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In an effort to more efficiently communicate with our membership, it is requested that members use electronic options (email) whenever possible. This will reduce copy and postage costs substantially. If members opt for US Postal Service delivery for general communications in addition to electronic communications, they will be charged a $20.00 fee. Please read the following statement and check the box to indicate your preference before signing this form.
Do you wish to receive general NTCA communications through the US Postal Service in addition to electronic communications? If yes, $42.00 fee applies.*
- YES
- NO
I agree as per the Bylaws of the NTCA to receive electronic communications (email). Communications will be limited to general mailings and announcements. This is a revocable agreement and I agree to release the NTCA, its Board, and Officers from any liability should communications be received late or not received by the member due to circumstances beyond the control of the NTCA.
We agree as per the Bylaws of the NTCA to receive electronic communications (email). Communications will be limited to general mailings and announcements. This is a revocable agreement and we agree to release the NTCA, its Board, and Officers from any liability should communications be received late or not received by the member due to circumstances beyond the control of the NTCA.
Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Applicant Signature*
Dual Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Dual Applicant Signature*
Name of of Parent/Guardian for a Junior Applicant (under age 18)*
First Last
Date*
MM slash DD slash YYYY
Signature of of Parent/Guardian for a Junior Applicant (under age 18)*

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I hereby apply for Junior Membership in the NTCA. I agree to abide by the Constitution and Bylaws, the Code of Ethics of the NTCA, and the rules and regulations of the AKC and NTCA, and to further promote the objectives of the NTCA by doing all in my power to protect and advance the interest in Norwich terriers through my sportsmanlike behavior in all areas.
Junior Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Junior Applicant Signature*
I hereby apply for Membership in the NTCA. I certify that I am 18 years of age or older, and that I have read the NTCA Constitution and Bylaws. I agree to abide by the NTCA Constitution and Bylaws, the Code of Ethics of the NTCA, and the rules and regulations of the AKC and NTCA. I further agree to promote the objectives of the NTCA by doing all in my power to protect and advance the interest in Norwich terriers, including but not limited to exhibiting good sportsmanlike behavior at AKC and NTCA events.
Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Applicant Signature*
I hereby apply for Membership in the NTCA. I certify that I am 18 years of age or older, and that I have read the NTCA Constitution and Bylaws. I agree to abide by the NTCA Constitution and Bylaws, the Code of Ethics of the NTCA, and the rules and regulations of the AKC and NTCA. I further agree to promote the objectives of the NTCA by doing all in my power to protect and advance the interest in Norwich terriers, including but not limited to exhibiting good sportsmanlike behavior at AKC and NTCA events.
Dual Applicant Name*
First Last
Date*
MM slash DD slash YYYY
Dual Applicant Signature*
The following questions to be completed by parent/guardian.
Child's application information may be sent to the NTCA membership for review.*
- Yes
- No
Child's name, address, and phone number allowed to be published in the NTCA directory.*
- Yes
- No
Child's name, address, and phone number allowed to be posted in the Members Only section of the NTCA website.*
- Yes
- No
Child allowed to receive Club-related emails from the NTCA.*
- Yes
- No
Name of Parent/Guardian for a Junior Applicant (under age 18)
First Last
Date*
MM slash DD slash YYYY
Signature of Parent/Guardian for a Junior Applicant (under age 18)*

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