WILD WILD WEST ASC

 

MEMBERSHIP APPLICATION

(Fiscal Year January 1^st – December 31^st)

Mail form to:

Elaine Osmun, PO Box 2201, Red Lodge, MT 59068

Youth $10.00; Single $20.00; Family $30.00

 

Membership (please circle one)        New     Renewal

Family $____  Single$____  Non-Voting/Supporting $____  Junior $____

 

Note: Dues must be paid before you can votes.  In order to serve as an officer or director, you must be a member of the Australian Shepherd Club of America, Inc. (ASCA).  You don’t have to own an Australian Shepherd to be a member.  If you need an application to join ASCA, please call, email, or visit http://www.asca.org on line.

 

Applicant’s Name:        ________________________________________________

Co-Applicant’s Name:  ________________________________________________

Co-Applicant’s Name:  ________________________________________________

 

ASCA #:                      __________________________________

Mailing Address:           __________________________________

                                    __________________________________

                                    __________________________________

 

PH# Home:      ______________________    PH# Work:      ________________________

Cell PH#:         ______________________    Email:               ________________________

Website:           ____________________________________________________________

 

Dog’s Name:    ____________________________________________________________

Dog’s Breed:    _____________________      Age:     __________    Sex:      ____________

 

Dog’s Name:    ____________________________________________________________

Dog’s Breed:    _____________________      Age:     __________    Sex:      ____________

 

Dog’s Name:    ____________________________________________________________

Dog’s Breed:    _____________________      Age:     __________    Sex:      ____________

 

Please State your goals on the back of the form

 

I, THE APPLICANT(S), AGREE TO ABIDE BY THE CONSTITUTION, BYLAWS, POLICIES, PROCEDURES, RULES, REGULATIONS, CODE OF ETHICS, AND DISPUTE RULES OF BOTH THE PARENT CLUB AUSTRALIAN SHEPHERD CLUB OF AMERICA, INC. AND THIS CLUB.

 

AREAS OF INTEREST:       Agility             Conformation Obedience

 

                                                Rally-O

 

STOCK DOG TRIALS:        Sheep              Cattle                          Ducks

 

                                                Others:_________________________________

 

NEWSLETTER:                    ___

SHOW SET-UP:                    ___

SHOW TAKE-DOWN:         ___

AWARDS:                             ___

SHOW SECRETARY           ___

SHOW COORDINATOR     ___

RING STEWARD                 ___

OTHER:                                 ___      PLEASE SPECIFY:   ________________

 

Signature of Applicant(s):      _______________________________________________

 

                                                _______________________________________________

 

                                                _______________________________________________

 

Note: Parent must sign along with any minor applicant.