INTERNATIONAL WHITE COLLIE CLUB
NEW MEMBER APPLICATION – 2007
NAME(s):_______________________________________________________________________
ADDRESS:___________________________________CITY:_____________________________
STATE/PROVINCE:__________________________POSTAL/ZIP
CODE_________________
PHONE: ( )______________________________FAX: (
)_______________________
E-MAIL:_____________________________________WEBSITE:________________________
Are you interested in serving the Club in an Official capacity? _______
YES , ________
NO
If, YES, please state office/committee you wish to serve & your
experience/qualifications:__________________
______________________________________________________________________________________________
Circle all related to you as a Collie person: a) owner b) breeder c) exhibitor
d) handler e)________
_____________________________________________________________________________________
Please check if you are a member of:
Collie Club of America_______Collie Club of
Canada________
Local Collie Club_________Interational Affiliatation________
Other club interests:_____________________________________________________________________________
_______________________________________________________________________________________________
MEMBERSHIP YEAR: JANUARY 1 –
DECEMBER 31
Dues received in the last quarter (Oct.-December) will be applied to
following year’s membership.
MEMBERSHIP DUES:
_______ Individual/$15.00 _______
Family/$20.00 ________
Junior/$5.00 (16 years & under w/parent(s) membership.
ALL OTHER COUNTRIES
________ Individual/$20.00
________ Family/$25.00 EUROS
ACCEPTED
I agree to abide by the Constitution, By-Laws & Code of Ethics
of the INTERNATIONAL WHITE COLLIE
CLUB. I (we) certify there are no
past or preset unresolved dog iossues on record at
time of my (our)
application(s).
If elected to office, I (we) will serve said club as a
whole and not abuse any office.
SIGNED:
________________________________________________________ DATE:
___________________
SIGNED:
________________________________________________________ DATE:
___________________
SPONSOR:
______________________________________________________ DATE:
___________________
Membership Chair:
Jacqueline Young-Barikan 21985
Accepted __________________ Rejected: __________________ Date Received: ___________
Dues Paid: _______________