SECURITY

Membership Application To apply for membership please complete all your questions.

Name

Address

City State Province

Postal Zip Code

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

Email

example@example.com

If you are applying as a new member what are the names and phone numbers of the two members sponsoring, you. If you don't know any members no problem, we are happy to reach out to you and help guide you with your membership application.

1

2

Have you at any time been associated with, or sold dogs to, a wholesale or retail canine operation?

Have you ever been suspended from the AKC or any other Dog Club

Please explain a yes answer to the above two questions

| agree to have meeting notices and other club notices sent by email

I understand that meetings occur by Zoom, typically on the 3rd Tuesday of each month

I authorize and consent to the released parties and those acting on their authority, the unrestricted right and permission to use, publish / republish any photographic or video images of me, my minor child, and or my dog for CACDC's promotional and marketing purposes. I also permit CACDC's use of any printed material in connection therewith and relinquish any right to review or restrict its use or publications, including website entries, without payment or any consideration. I understand and agree these materials will become the sole and exclusive property of CACDC.

I (we) have answered these statements honestly and I (we) certify that I (we) am (are) in good standing with the American Kennel Club. I (we) agree to abide by the rules and regulations of the American Kennel Club as well as the Constitution and Bylaws and policies of the Cascade Australian Cattle Dog Club (CACDCCheck this box to indicate the above statement to be true TRUE

If applying as a new member please list the AKC registered names and numbers of your ACD's to aid in our annual awards.

Name Print

Date

Signed