Membership Candidate Application (Please Print)
List Name of Each Adult Member: _____________________________________________
_____________________________________________
List Name of Each Junior Member (under 18 years of age):
_________________________ Birth Date _____________
_________________________ Birth Date _____________
Address: _______________________________________________________________________
City/State/Zip: _______________________________________________________________________
Home Phone: _________________________ Work / Cell Phone (Optional): ______________________
E-mail Address (Optional): _________________________________________________
Are you a member of ASCA? __________ If yes, membership number: __________________________
How many dogs do you own? __________ What breeds? ____________________________________
____________________________________
Check all areas of interest:
____ Agility ____ Conformation ____ Fly Ball ____ Herding ____ Obedience _____
____ Tracking ____ Other (specify) ______________________________________________________
Check Membership Desired:
___ Family* ($22.50) - Includes two adults and their children under age 18 - 2 votes.
Each additional adult family member wishing to join in the same household is $7.50
___ Individual* ($15) - Includes one adult age 18 or older - 1 vote
___ Junior* ($7.50) - For individuals under 18 that are not included in a family membership - No voting rights.
___ Subscription to Newsletter Only ($10) - No voting rights.
*Includes a subscription to GASC Newsletter
Any donation above the price of the annual membership is greatly appreciated and helps
defray postage expenses.
I/We hereby agree to abide by the Constitution, Bylaws, Rules, Regulations, Code of Ethics, and Rules for Resolution of Disputes
of both ASCA and The Gateway Australian Shepherd Club. (Membership shall be open to all persons who are in good standing
with the Australian Shepherd Club of America and GASC.)
Signature of Each Adult Member Listed Above:
_____________________________________________ Date: ___________________________
_____________________________________________ Date: ___________________________
_____________________________________________ Date: ___________________________
Signature of Parent/Legal Guardian if this membership is for junior only:
_____________________________________________ Date: ___________________________
Send this completed form, along with your check made payable to Gateway ASC to:
Becky Androff
3301 Putnam Avenue
Belleville, Illinois 62226
List Name of Each Adult Member: _____________________________________________
_____________________________________________
List Name of Each Junior Member (under 18 years of age):
_________________________ Birth Date _____________
_________________________ Birth Date _____________
Address: _______________________________________________________________________
City/State/Zip: _______________________________________________________________________
Home Phone: _________________________ Work / Cell Phone (Optional): ______________________
E-mail Address (Optional): _________________________________________________
Are you a member of ASCA? __________ If yes, membership number: __________________________
How many dogs do you own? __________ What breeds? ____________________________________
____________________________________
Check all areas of interest:
____ Agility ____ Conformation ____ Fly Ball ____ Herding ____ Obedience _____
____ Tracking ____ Other (specify) ______________________________________________________
Check Membership Desired:
___ Family* ($22.50) - Includes two adults and their children under age 18 - 2 votes.
Each additional adult family member wishing to join in the same household is $7.50
___ Individual* ($15) - Includes one adult age 18 or older - 1 vote
___ Junior* ($7.50) - For individuals under 18 that are not included in a family membership - No voting rights.
___ Subscription to Newsletter Only ($10) - No voting rights.
*Includes a subscription to GASC Newsletter
Any donation above the price of the annual membership is greatly appreciated and helps
defray postage expenses.
I/We hereby agree to abide by the Constitution, Bylaws, Rules, Regulations, Code of Ethics, and Rules for Resolution of Disputes
of both ASCA and The Gateway Australian Shepherd Club. (Membership shall be open to all persons who are in good standing
with the Australian Shepherd Club of America and GASC.)
Signature of Each Adult Member Listed Above:
_____________________________________________ Date: ___________________________
_____________________________________________ Date: ___________________________
_____________________________________________ Date: ___________________________
Signature of Parent/Legal Guardian if this membership is for junior only:
_____________________________________________ Date: ___________________________
Send this completed form, along with your check made payable to Gateway ASC to:
Becky Androff
3301 Putnam Avenue
Belleville, Illinois 62226
..