USA-BOX Membership Form

USA-BOX New Member Questionnaire
USA-BOX reserves the right to request additional information from Applicant based upon the information recieved, or provided by sponsors.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Addl. Member Name - Family Memberships

First NameLast Name
Addl. Member Email
example@example.com
Addl. Member Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website
Kennel Name
(If Applicable)
Name one USA-BOX Member who would be willing to sponsor you
Sponsor Name*

First NameLast Name
What is your interest in becoming a USA-BOX Member?
Have you titled a Boxer in the last 3 years? If yes, check all that Apply:
Please list any other clubs you are a current member of
Please List Registered names of Boxers currently living in your home
Number of Litters you have bred or co-bred in the last 3 years.
Have you ever sold a dog for resale?
If yes, please explain:
The applicant submitting this form agrees that all information set forth is true.

Any false, misleading or incorrect information may be grounds for rejection of this application or termination of membership if discovered after accepted.

Every question must be answered.

If the Applicant is not accepted for membership, dues will be refunded.
Person Submitting Form*

First NameLast Name

Alternate Method: Print form and Mail with Check to:

USA-BOX, 10170 Dickenson Rd. Winnebago, IL 61088
Payment
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Lifetime Membership$ Free
For USA-BOX Lifetime members only

Renew Single$60.00
Includes $15.00 Late Fee

Renew Family$75.00
Include $15.00 Late Fee

New Member Single $45.00

New Member Family$60.00

Total $0.00
Should be Empty:

USA-BOX Membership Application