Please send completed form to:
Maurice Hill
430 E. Broadway
Crystal Lake IL 60014


Any questions please contact:
Pam Hughes
198 Bates Rd.
White Salmon, WA 98672-8504

The United States Lancashire Heeler Club Membership Form
Name:__________________________________Address:_______________________________________________
_____________________________________________________________________________________________

Zip/Postal Code:
________________ State/Province:_________________ Country:__________________
Phone:
____________________ Fax:____________________  Email Address:_______________________________
New Membership _____  Renewal _____

How many Lancashire Heeler's do you own? (please tell us about them!  Ages, color etc )_________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Please tell us about your other pets... ________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

What are your Interests (please check those that apply): Breeding _____ Showing _____ Obedience _____ Herding _____
Other (please specify) ______________________________________________________________________________________

Would you be interested in helping with club tasks? ______  If so, please tell us how you'd like to help! ________________________
________________________________________________________________________________________________________


Membership dues are $35.00 in United States funds and are due January 1st of each year.
Please make cheque or money order payable to The United States Lancashire Heeler Club.

I hereby make application to the United States Lancashire Heeler Club and agree, if accepted for membership, to adhere to the
policies, guidelines, constitution and by-laws set forth by the club.  The above information is true and accurate.  I understand that my
membership is subject to the club's approval.

Sign ______________________________________________ Date ___________________________