Sunshine State
Australian Shepherd Club
Name:_______________________________ ASCA Membership #:__________________
Children's Names: ________________________________________________________
Address: _________________________________________________________________
:
Day Time Phone #: _____________________Evening Phone #: _____________________
E-Mail Address: ____________________________________________________________
Type of Membership:
Single [ ] $10.00 Family: [ ] $12.00 Subscription: [ ] $5.00 Junior: [ ] $3.00
Your Interests: Agility [ ] Conformation [ ] Herding [ ] Jr. Showmanship [ ] Obedience [ ]
ASCA Kennel Name (if applicable) _______________Years in Australian Shepherds:_____
Breeds of Dogs that you own: _________________________________________________
Committees that you would like to serve on: ______________________________________
What YOU would like to gain/learn from this club ? _________________________________
How could YOU help this Club ? _______________________________________________
What activities would you like the club to have? ____________________________________
What other clubs/associations are you a member of ? ______________________________
SPONSOR NAME OR SIGNATURE: _____________________________________________
SPONSOR NAME OR SIGNATURE: _____________________________________________
If accepted for membership, I agree to abide by the ASCA Articles of Incorporation, By-laws, and all ASCA Rules
and Regulations governing the ASCA Registry and all other ASCA programs. I will also agree to abide by the
SSASC By-laws.
Signature of Applicant: ________________________________Dated: ________________
Signature of Applicant: ________________________________Dated: ________________
Mail completed application to:
Sunshine State ASC, % Glenda Stephenson, 163 Anderson Ave NE, Palm Bay, FL 32907
