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MBR #_________________ Amount Paid $___________ |
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Established 1991 |
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Membership Application |
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Name:____________________________________ |
Phone: ( ____ ) __________________________ |
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Address:__________________________________ |
Fax: ( ____ ) ____________________________ |
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City: _____________________________________ |
State: _____________ |
Zip: ______________ |
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Occupation: _______________________________ |
E-mail: _________________________________ |
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Registered Kennel Name (if any):___________________________________________________________
Please list two references that we can contact. One MUST be a SSDCA, Inc. member in good standing.
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Name: __________________________________ |
Phone: (____ )____________________________ |
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Name: __________________________________ |
Phone: (____ )____________________________ |
Are you now or have you been a member of any other clubs?
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Name: __________________________________ |
Type of Club: ____________________________ |
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From: ______________ |
To: _______________ |
Did you hold any office? ___________________ |
Please list any additional club affiliations/positions held on the back of this application.
If asked, would you be willing to function in any particular office or on any
committee, or is there any service to
the club you would like to
perform?_________________________________________________________
How many Shiloh Shepherds do you own?_________Are they: □ Show □ Breeding □ Working □ Pet quality?
Name of your Shiloh Shepherd: _________________Breeder's Name: _____________________________
If you would like to tell us more about your dogs, your breeder, etc., please
do so on the back of this
application.
Do you plan on purchasing another Shiloh Shepherd in the future?____________When?_______________
What are the exact requirements for the dog you will purchase next?________________________________
____________________________________________________________________________________
Do you plan on showing your dog if he/she has all the quality requirements?_________________________
Please state your past experience in dog showing/training on the back of this application.
What other plans do you have for the Shilohs you now own/plan to acquire in
the near future. (Please check all
that apply.)
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□ Obedience |
□ Search and Rescue |
□ Schutzhund |
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□ Therapy Dog |
□ Agility |
□ Herding |
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□ Service Dog |
□ Police Work |
□ Other |
A short statement as to why you would like to be a member would be appreciated: ____________________
___________________________________________________________________________________
A short statement as to what you expect from/what you can do for our club would be appreciated:_________
___________________________________________________________________________________
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Please list any additional comments/concerns on the back of this application. Thank you.
Please enclose the appropriate fee and sign below.
| First year $35 (renewal $25 each year thereafter) | Two years $55 | Three years $75 |
With my signature____________________________________ I agree to abide by the
Constitution and the
By-laws of the SSDCA Inc. and, if applicable, the Breeders
Code of Ethics. All the information given above is
correct to the best of my
knowledge. I understand that any fraudulent statements made herein could lead to
the
revocation of my eligibility.
Mail completed application and membership fee to:
SSDCA, Inc. Membership
Coordinator
c/o Olga Twombly
43242 Lecroy Circle
Leesburg, VA 20176
or fill out our on-line membership application!
