| SCOTTISH TERRIER CLUB OF
AMERICA |
| MEMBERSHIP REAPPLICATION |
|
| APPLICANT'S NAME:
_________________________________________ |
| ADDRESS:
___________________________________________________ |
| ____________________________________________________________ |
| Telephone: ___________ Fax: ___________ E-Mail:
___________________ |
| YEAR OF LAST DUES PAYMENT:
_______________________________ |
| YOUR INVOLVEMENT IN SCOTTISH TERRIERS:
__________________ |
| _____________________________________________________________ |
| _____________________________________________________________ |
| SPONSORS: It is necessary to have two (2) Sponsors |
| 1. Name:
___________________________________________________ |
| Address:
_________________________________________________ |
| Telephone:
________________ E-Mail: _________________________ |
| 2. Name:
___________________________________________________ |
| Address:
_________________________________________________ |
| Telephone:
________________ E-Mail: _________________________ |
|
| Please initial the following two statements: |
| ___________ I/We are enclosing a signed STCA Code of
Ethics. |
| ___________ I/We are enclosing payment of dues for this
year. |
|
| _____________________________
_______________________________ |
| Signature
Date Signature
Date |
|
| (Do not write in this
space) |
Date application received:
____/____/________ Amount of check $_________ Sponsors Approved (1)
______ (2) ______ Code of Ethics signed ______ Date of Acknowledgment
____/____/________ Board Action ______ Membership Date
____/____/________ |
|