BCSA AFFILIATE CLUB MEMBERSHIP APPLICATION/RENEWAL FORM
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To apply for Affiliate Club Membership or to renew your current membership, enter your information in the fields below and select the "print" option on your browser.  If you choose to hand print your application, make certain all information is legible.

Please sign and mail the application, along with your membership fee and required documents (see "Required" below), to Kathy Sours, BCSA Membership Chair, 3821 W Charter Oak Road, Peoria, IL 61615. 

CLUB INFORMATION:  
Club Name:
Address:
City/State/Zip:
Contact Information:
Name:
Telephone --
E-Mail
Re-enter E-mail:
Required:

  • At least one member of the applying club must be a member of BCSA.

  • A copy of the current club roster showing names, address, email etc.

  • A copy of the Club's constitution and by-laws

  • A copy of the current Board including name/address, phone number, email

  • BCSA Membership Chair's name/address (see below) must be added on to any newsletter mailing that goes out from the Club.

You must enclose the items above for your Club's membership to be processed.
   
Affiliate Club

Dues $50 Note: Memberships must be renewed annually. 
Apply/Renew:
Meeting Notices
(check one):
YES Send BCSA meeting notifications via e-mail.
NO Send BCSA meeting notifications via US mail.
National Specialty
Premium list
(select one):
YES Mail my National Specialty Premium list.
NO Do not mail premium list.  I will view on the BCSA web site.
   
I Agree To: Comply with the attached Code of Ethics of the Border Collie Society of America. To support the Constitution and Bylaws of the Border Collie Society of America. To strive to fulfill the Mission and Vision of the Border Collie Society of America.
Authorized Club Signature: ____________________________________________________

Mail with required documents to:
BCSA Membership Chair, Kathy Sours, BCSA Membership Chair, 3821 W Charter Oak Road, Peoria, IL 61615. 

(BCSA Use: Rec'd: ____________  Board: ____________  Approved: _____________)

Form Updated 10.22.2009