| SCOTTISH TERRIER CLUB OF
AMERICA |
APPLICATION FOR JUNIOR MEMBERSHIP
Junior Members, 10 to 17 years of age |
|
| NAME: ______________________________________________________ |
| ADDRESS: ___________________________________________________ |
| __________________________________________________________ |
| Telephone: _____________________ E-MAIL: ________________________ |
| BIRTH DATE: ___________________________ A Junior Member will be eligible to convert
his/her membership to full membership at the dues cycle following the 18th birthday. |
| PARENT/GUARDIAN NAME ___________________________________________ |
| PARENT/GUARDIAN ADDRESS________________________________________ |
| ____________________________________________________________________ |
| JUNIOR APPLICANT’S INVOLVEMENT WITH SCOTTISH TERRIERS: |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| JUNIOR APPLICANT’S INVOLVEMENT IN SCHOOL AND COMMUNITY ACTIVITIES: |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| SPONSOR #1_______________________________________________________ |
| Address___________________________________________________________ |
| SPONSOR #2_______________________________________________________ |
| Address___________________________________________________________ |
|
| Please Initial the following: |
| ____ I have read, signed and sent a copy of the STCA Code of Ethics with this application.
|
| ____ I have included the application fee and first year’s dues fee of $45.00 with this application.
|
| ____ I have notified my sponsors requesting the sponsor’s form be sent to the Membership
Chairperson. |
|
| ______________________________________________ ___________________ |
| Signature of applicant
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
____/____/________ |
|
Membership
Application
