By completing this form you are agreeing to the use of your name and other personal information as a part of the Charleston Kennel Club’s Breeder Referral Program.  If at anytime you choose to be withdrawn from the program you must do so in writing to the club’s referral volunteer and or webmaster.

The Charleston Kennel Club breeder referral volunteer will provide those individuals requesting breed information with the names of any member having a specific breed and enrolled in the program.

Please complete a form for each breed you wish to enroll.  Only complete those portions that apply. 

Send to CKC, Breeder Referral Program, 428 Rocky Road, Bonneau, SC 29431 .

Breed _______________________________ Kennel Name _________________________________

Your Name ______________________________________ Phone ___________________________

E-mail ____________________________________________________________________________

Website ___________________________________________________________________________

Check all following that apply:

Available to provide information on breed _______      Puppies occasionally available _______     

Older dogs occasionally available _______     Stud service _______      Puppy referral _______

If you wish to have your contact information listed on the club website (www.charlestonkennelclub.org) Breeder Referral Page, please check here ____________

 Signature ________________________________________________ Date ____________________