BCSA: Membership Application

MEMBER INFORMATION

First Name:

(R)

Last Name:

(R)

Household Name:

(R) Enter N/A if Individual Membership.

Address:

(R)

City/State/Zip:

(R) (R) (R)

Best Telephone:

(R)

E-mail:

(R)

Note:

-- Members with an e-mail address will receive the annual Membership Roster via e-mail.
-- Make certain the Membership Chair is notified if your e-mail address changes.
-- Enter N/A to have the Roster mailed.

PAYMENT:

(R)

MEMBER PREFERENCES/SIGNATURE

Membership Type:

(R)

Meeting Notices:

(R)

Agreement:

(R)

By selecting "AGREE", I agree to comply with the Code of Ethics, to support the Constitution and Bylaws and to strive to fulfill the Mission and Vision of the Border Collie Society of America.

Applicant's Signature:

(R)

By selecting "YES", I confirm that it has the same effect of my personal signature.

Household Signature:

(R)

Select N/A if Individual Membership. Household Membership: By selecting "YES", I confirm that it has the same effect of my personal signature.

	Complete the form below to renew your BCSA Membership. Review all information carefully before pressing "Submit Renewal". After you "Submit" your form, you will have the option of paying your dues with a credit card via PayPal or mailing your payment. (R) = Required Information