SECURITY

Membership Application

Renewal & New Membership
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
YesNo
YesNo
Please explain a yes answer to the above two questions
Yes
Yes
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.

YesNo
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

MonthDayYear
Date
Signed
Should be Empty:

Membership Application