Application
GITCA Breeder and Contact List
If you would like to participate in the Breeder and Contact List, please provide the following information:
1) Name ______________________________________________________________________________
2) Methods of contact (may list tel. number/e-mail/website)___________________________________
3) State of residence (optional field) _______________________________________________________
4) Length of time in the breed (3 year minimum required)______________________________________
5) Years as GITCA member (minimum 2 years for Contact, 3 years for Breeder) _____________________
6) Please provide answers to the following whether or not you consider yourself a Breeder.
 Have you bred any 2 years out of the last 3 consecutive years (including supplying a sire or
leased dam)?
Yes______ No______
 Have you bred a current litter for sale or do you intend to breed a litter for sale within 1 year
from the date of this application?
Yes______ No______
 Do you have plans to provide a sire or provide a leased dam to another breeder within 1 year
from the date of this application?
Yes______ No______
7) Interests applicant has participated in with Glens, for example: breeding, conformation, agility,
earthdog, therapy dog. NOTE: The listing of interests is optional UNLESS you answered yes to any part
of question 6, in which case you meet the definition of Breeder for the purposes of this list. Breeders
MUST list breeding as an area of interest to participate in the list.
_____________________________________________________________________________________
8) If you answered yes to any part of question 6, please provide a CHIC number for one dog.
IMPORTANT: Please refer to Breeder and Contact List Information found at glens.org, Members Only for
additional list requirements for Breeders.
CHIC #________________________________________________________________________________
The below-signed member affirms intent to follow the GITCA Code of Ethics in any communication
resulting from this contact list. The member agrees to respond to anyone who contacts them in a
timely manner. The member also agrees to comply with the Additional Requirements for Members
Identified as Breeders found in Breeder and Contact List Information located on glens.org, Members
Only, if the above definition of Breeder applies. Intentional failure to comply with this agreement will
result in removal from the Breeder and Contact List.
PRINT NAME________________________________________________
SIGN NAME_________________________________________________
DATE_________________________________
Please send this completed form to:
Maggie Weidinger, GITCA Corresponding Secretary
146 Victoria Road, Millersville, PA 17551
Questions? Send them to gitcacs@glens.org
9/2014
Thank you for being a GITCA volunteer