Membership Application Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Occupation * BIrthday * Birthday MM DD YYYY Please Agree to Accept Meeting Notices via email * Yes, send BCSA Meetings Notices via Email Membership Type * $25- Associate $15- Junior $50- Single (Sponsor Required) $60- Household (Sponsor Required) Sponsor Name If you are submitting your application as a Single or Household member, please provide Sponsor's name. First Name Last Name Name of Household Member If you chose the Membership Type "Household", you MUST list the second Household member. First Name Last Name Agreement * I agree to comply with the Code of Ethics, to support the Constitution and Bylaws and to strive to fulfill the Mission and Vision of the Border Collie Society of America. Applicant's Signature * By selecting "YES", I confirm that it has the same effect as my personal signature. Yes Household Signature Select N/A if Individual Membership. Household Membership: By selecting "YES," I confirm that it has the same effect as my personal signature. Yes N/ A Breeds Owned * Number of Years in Border Collies * Number of Border Collies Currently Owned * Border Collie Litters Bred in Last 3 Years * List the Border Collie rescue organization in which you are a member Areas of Interest (Agility, conformation, herding, obedience, etc. – list all that apply.) * Titles (List highest title in each category which you have earned and number of titles at that level, UDX5 for example.) Last Year Check All That Apply Competed in an AKC Event Competed in any Canine Event Special Skills * Club Activity * List areas of Club-related activity in which you would like to become involved. Committees * List Committees on which you would like to serve. Approved Judge If you are an approved judge for any canine activity, list which activity and organization (ex, Herding/AKC). Special Notes Thank you!
