Membership Application Form

Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Cellular Number
USCA Membership Number
USCA Expiration Date

MonthDayYear
Date
Registered name of your K9 you will be working.
Call name?
Date of Birth
AKC or Foreign Registration Number
Male/Female

MaleFemale
Neutered/Spayed

YesNo
Have you had your dogs hips and elbows x-rayed?

YesNo
Is your dog's rabies vaccination up to date?

YesNo
If yes, please provide us with details about the results.
Have you ever title a dog in Schutzhund? If so, please state the highest level you competed.
What are your goals in the sport?
IGP is very demanding. How many hours each week are you able to train your dog?
As a member of the club you will be asked to assist when we are putting on an event and during club days, are you okay with this?
Do you have any physical limitations we should be aware of?
Please provide any information about you are your K9 partner.
Membership Type
prevnext( X )
1 Dog Year Membership
$500.00

2 Dog/One year MembershipRequires approval
$850.00
Billing Adress

Use the address above.I want to specify a different billing address.
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Signature*

MonthDayYear
Date
Signature*

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