Name ___________________________________________ ASCA Membership # ____________
Address________________________________________________________________________
City ______________________________________________Zip_____________
Kennel Name________________________________________ E-Mail ______________________
(H) Phone ______________________________ (W) Phone_______________________________
What information would you like published on the WEB site? name? ____e-mail? ______ phone? _________
ڤ Family (2 votes) $12.50
ڤ Single (age 18 and over - 1 vote) $10.00
ڤ Newsletter Only $ 5.00
ڤ Junior (no vote) $ 5.00
Memberships received after Oct 1 of the current year will be considered paid for the following year.
Please fill in names and date of birth of each person covered in the membership. This is also for the newsletter.
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I would like to help the club in the following ways:
ڤ Show Secretary ڤ Steward ڤ Newsletter ڤ Board ڤ Show Help
Please check all interest boxes that apply:
ڤ Agility ڤ Conformation
ڤ Flyball ڤ Herding
ڤ Obedience ڤ Tracking
Let us know if you have any special expertise that you would be willing to use for the club.
_________________________________________________________________________________________
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I ___________________________________ promise to promote the Australian Shepherd as an all around working dog and to abide by the constitution, rules, regulations, bylaws, code of ethics and dispute resolution rules of OASC and the Australian Shepherd Club of America.
Signatures of all members listed in this application ________________________________________________________________________________________________________________________________________________________________________________________________________________
Date: ______________________
Please forward this application and fees to: Outback Australian Shepherd Club
Sara McDonough-Elsenpeter 14828 89th St NE Otsego MN 55330 Phone number 612-839-4524 for information - [email protected]