USABC_Membership_Application

Membership Application United States American Bulldog Club
United States American Bulldog Club

Membership Application
Please fill out this form in its entirety and print clearly. Yearly Dues: $31.50 for individual membership and $57 for family membership (living in the same household)
Name of Applicant (1)*

First NameLast Name
Name of Family Applicant (2)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (1)*
Please enter a valid phone number.
Phone Number (2)
Please enter a valid phone number.
Email (1)*
example@example.com
Email (2)
example@example.com
Club Affiliation Name & No.
WAIVER OF LIABILITY

I understand that participation in events is at my own risk. I will not hold United States American Bulldog Club, Inc. or any individuals representing United States American Bulldog Club, Inc. responsible for damage that may occur to my person, property, or dog as a result of the participation in trials or other activities held by the organization.

I understand that the training of my dog for all United States American Bulldog Club, Inc. events is my responsibility and I will conduct my training responsibly and humanely and with the best interest of my dog in mind.

I understand that it is my responsibility to carry ample insurance to cover potential damages my dog may cause or incur at United States American Bulldog Club, Inc. events.

I understand that it is my responsibility to read the Bylaws of the organization and to abide by them.

I understand that I alone am responsible for my actions and the actions of my dogs and I agree to keep my dogs under control at all United States American Bulldog Club, Inc. events.

I have read and agree to the above Waiver of Liability.
Applicant Signature

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Date

MonthDayYear
Date
Family Applicant Signature

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Date

MonthDayYear
Date
Breeder/Mentor:

Please send this signed and completed membership application and one full year membership dues.

Make checks/ Money Orders payable to:
Diane Donnelly - USABC Secretary
PO Box 1124, Levittown, PA 19058-1124

Pay by Paypal
Email to: info@usamericanbulldog.com

FOR INTERNAL OFFICE USE ONLY

DATE RECEIVED: __________________

EXPIRATION DATE: _________________

MEMBERSHIP NO. ASSIGNED:________________________________

FAMILY MEMBERSHIP NO. ASSIGNED:__________________________
Should be Empty:

United States American Bulldog Club