To apply to the Houston Area Papillon Club, please print out this form, answer it, and mail it and a check or money order for $20 (made out to HAPC) to:

HAPC
c/o: Nancy Ferverda
700 Bayou Crest
Dickinson, TX  77539

Only one applicant per form

1. Full name: ___________________________________________________________

2. Home address (including city and zip):
_______________________________________________
_______________________________________________

3. At least one phone number:_______________________________________________

4. E-mail address:_______________________________________________

5. Do you own any Papillons?:   yes   /   no

6. Have you registered a litter of puppies in the past 3 years with the AKC?:   yes   /   no

7. Do you participate in any AKC event(s) with your Papillon (please specify: conformation, agility, and/or obedience)?:
______________________________________________________

8. Do you participate in any non-AKC event with your Papillon (example NADAC, Flyball)?:
______________________________________________________

9. Are you an AKC licensed judge?:   yes   /   no

10. Signature: ______________________________________________________