2023 Medallion Application

2024 Online Medallion Application
Submit a separate form for each dog.

This form must be completed by February 28, 2025

IMPORTANT: Only one medallion per dog, per lifetime will be awarded by the ISCA. You must be a current member and have renewed your dues by January 31, 2025. All owners and co-owners must be members in 2024 and 2025.

IT IS NOT NECESSARY TO SUBMIT PROOF OF TITLE(S) EARNED.
Purpose of this application (you may choose more than one of the answers below if appropriate):

To receive this dogs first medallion (one per dog, per lifetime). This dog has not previously received a medallion.For recognition only, no medallion awarded – dogs name/title is published in the Memo and at Awards dinner.To purchase medallion(s) for title(s) earned in 2024. This dog has already received its first medallion (or it is applied for on this application).

Dog and Owner Information
Dog Name (No titles please):*
AKC Registration Number:*
Owner's Name (include all owners):*
Address, City, State and Zip:*
Phone:*
Email Address (type carefully - this will be used to send you a confirmation email):*
Are you attending the National:*

YesNoSomeone else will pick up my medallion

If this dog has already received its “one per dog, per lifetime” medallion, members may purchase additional medallions for titles earned. Members may not backorder medallions for previous years using this form.

Mail a check payable to the ISCA:

1) in the amount of $30 per medallion if being PICKED UP at the national or
2) in the amount of $40 per medallion if being SHIPPED after the national

Send check to or you can pay with Credit Card later on this form:

Debbie Davis

635 S M 75

Boyne, MI 49712

BE SURE to include a note with your check what you are paying for (dog name and title).
Will you be paying with a Check or Credit Card?*

CheckCredit CardI don't owe any money

If paying with a Credit Card, pick the appropriate amount:*

$10 - shipping of FIRST medallion for your dog$30 - purchasing a second medallion - will pick up at the National$40 - Purchasing a second medallion - and shipping
Total due for Medallion
Total Due ISCA

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