| SCOTTISH TERRIER CLUB OF
AMERICA |
| APPLICATION FOR MEMBERSHIP |
|
| Date:____________________________ |
| I/We:
_________________________________________________________ |
| (Print or type your name
and Kennel prefix as you wish it to be printed in the club roster) |
HEREBY MAKE APPLICATION TO BE MEMBER(S) OF THE SCOTTISH
TERRIER CLUB OF AMERICA. IF ELECTED TO MEMBERSHIP IN THIS CLUB, I/WE AGREE TO
ABIDE BY THE CONSTITUTION AND BY-LAWS, AND CODE OF ETHICS OF THE STCA.
|
| How long have you been involved with Scottish Terriers?
______________ |
| Do you own or co-own a Scottish Terrier? ____ How many?
___________ |
| Do you own or have you owned other dogs?
________________________ |
| What
breeds?_________________________________________________ |
| Have you bred dogs? Yes __________ No __________ |
| If yes, how many litters
total?____________________________________ |
| For each litter in previous three calendar years, list
litter, the breed, sire and dam, date whelped and number in litter: |
|
Breed |
Sire and Dam |
Date Whelped |
# in litter |
| Litter 1: |
|
|
|
|
|
|
|
|
|
| Litter 2: |
|
|
|
|
|
|
(Please attach separate sheet for additional litters,
if needed.)
|
| Have you ever exhibited
dogs?___________________________________
_____________________________________________________________ |
| Do you breed or intend to breed in the
future?_______________________ |
| Do you sell or buy dogs/litters for
resale?___________________________ |
| Have you ever sold puppies to a pet shop, broker or
other store?________ |
Have you, either as an individual, or as an agent,
principal, employee, or volunteer, or in any other capacity, on behalf of any
organization or entity of any kind, advocate or supported any type of
legislation, regulation or public policy restricting the right to own or breed
dogs, including but not limited to, mandated sterilization, permits to own
intact dogs, permits to breed dogs, or any other restrictions or requirements
related to dog breeding?
Yes ______ No ______ |
| If you have answered Yes, please give an
explanation__________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________ |
| Describe, in detail your involvement with Scotties
(i.e. breeder/exhibitor, obedience, tracking, pet companion,
etc...)____________________________
_______________________________________________________________ |
| List the Regional Breed Club and/or All Breed Clubs to
which you have belonged and years of
membership__________________________________
_______________________________________________________________ |
| List positions held in
clubs_________________________________________ |
| Suggest any club committees on which you would like to
serve ___________
_______________________________________________________________ |
| If so,
why?______________________________________________________ |
| Applicant(s) occupation?
__________________________________________ |
Names and Addresses of Sponsors:
(1)
____________________________________________________________
(2)
____________________________________________________________ |
Signature(s) of Applicant(s)
Mr./Mrs./Ms.
__________________________________________________
Mr./Mrs./Ms.
__________________________________________________ |
| Mailing Address:
________________________________________________ |
| (Please print or
type) |
|
|
________________________________________________ |
| Phone Number: Area
Code(_____)___________________________________ |
| Fax Number: Area
Code(_____)___________________________________ |
| Email Address:
___________________________________________________ |
|
| Please check one: Enclosed is a check for
$70.00 for family membership___ |
| Enclosed is a check for $60.00 for
individual member___ |
|
| (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
____/____/________ |
|
Membership
Application
