New Member Application Form

New Member Application Form

Fill out the form carefully and completely. SICDTC Constitution & Member Incentives can be found on the Member Page on our website at www.sicdtc.org PLEASE NOTE: Membership dues to SICDTC 501(c)(4) organization are not deductible as charitable contributions.
Requirements for Membership Application:

1. Completed 2 sessions of 6 or 8 week classes at SICDTC

2. Attended 2 General Membership Meetings on Zoom or In-Person

3. Worked 2 hours for the club as a volunteer

If you have any questions, please contact our membership coordinator Geri Crane:

rallyregistrar@sicdtc.info
Type of Membership: May choose multiple membership options if applicable
LEGAL Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Occupation
Cell Phone Number
Format: (000) 000-0000.
Birthday -Month & Date (no year)
This is for our Birthday Greetings each Month. Skip to opt out
Junior Membership ONLY: Please Give FULL DOB including year

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact

First NameLast Name
Emergency Contact Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
#1 Dog's Call Name/Breed (if more space needed use comment box at the end)

NameBreed
#2 Dog's Call Name/Breed (if more space needed use comment box at the end)

NameBreed
Date of SICDTC Meeting Attended #1

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of SICDTC Meeting Attended #2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
#1 Name of Class COMPLETED at SICDTC & Date (approx)
#2 Name of Class COMPLETED at SICDTC & Date (approx)
Dates and type of job worked -Must equal at least 2H
Name of Board Member Sponsor (Confirmation will be sent by club for signature)
Name of Member in Good Standing Sponsor ((Confirmation will be sent by club for signature)
Name of Additional Family Member Living in Same Household Applying for Membership (if applicable): may use comment box for additional members

First NameLast Name
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
As a member, you are required to work 16hours /club year (July-June) 4H must be at a Trial. Please indicate which jobs would be of interest to you.
Primary Member Please Sign Below
Optional: Tell us something about yourself to help us know you better. Why do you want to join this club? Add Additional Notes/Comments
Membership Fees: Payment must be submitted with application. If you have trouble submitting payment with this form please send email to Desma at SICDTC@hotmail.com
prevnext( X )
Individual Primary Membership Fee
$45.00



Individual Junior Membership
$45.00



Family Membership Fee
Must include 1 Individual Membership. Family Member must live in same household (see Constitution on website for more details)

$5.00 Quantity



Help Us Pay Processing Fees
Optional: If you would like to help cover some of our processing fees please select. Thank you!

$4.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

New Member Application Form

Membership Fees: Payment must be submitted with application. If you have trouble submitting payment with this form please send email to Desma at SICDTC@hotmail.com*

Payment Methods

Membership Fees: Payment must be submitted with application. If you have trouble submitting payment with this form please send email to Desma at SICDTC@hotmail.com