Application for Member Club Status

Application for Member Club Status

Dues are $25 per year March 1 to Feb 28
Date of Application

MonthDayYear
Date
Date Club Established

MonthDayYear
Date
Club Name:
Name of Club Contact:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Main Disciplines (No more than three):
Please upload a club logo if applicable:

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Please upload your club's bylaws here

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Statement of agreement (signed by two club officers): As a member of the aforementioned club, I have read and agree to abide by the constitution, bylaws, and ordinances of the Working Dutch Shepherd Association of America. I shall do my best to uphold its objectives and ideals, and agree to promote and preserve the character and health of the Dutch Shepherd as set forth by the WDSAA.
Name

First NameLast Name
Officer Position
Clear
Date

MonthDayYear
Date
Name

First NameLast Name
Officer Position
Signature

Clear
Date

MonthDayYear
Date
Member Roster (Officers may hold multiple positions. All members must have WDSAA membership)*
Please verify that you are human*
My Products
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Club Application
$25.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.