New Member Application BCSA New Member Application Complete the form below to apply for BCSA Membership. Your sponsor must complete either the online Sponsor Form or print and mail in the Sponsor Form. Review all information carefully before pressing "Submit Application." * = Required Information Applicant InformationName* First Last Household Name*Enter N/A if individual membership.Age*18 or over17 or underAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Best Telephone*Email*Note: Members with an email address will receive the annual Membership Roster via email. Make certain we are notified if your email address changes. Enter N/A to have the Roster mailed. Sponsor's Name*Note: Membership applications will not be processed unless a sponsor name is listed and your sponsor completes the Sponsor Form. First Last Membership InformationMembership Type/Dues*$50 – Individual$40 – Associate$60 – Household$15 – JuniorMeeting Notices*Select OneYes, send BCSA meeting notifications via emailSend BCSA meeting notifications by U.S. mailAgreement*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. Select OneAgreeDon't AgreeApplicant's Signature* By selecting "YES", I confirm that it has the same effect as my personal signature.YesNoHousehold Signature*Select N/A if Individual Membership. Household Membership: By selecting "YES," I confirm that it has the same effect as my personal signature.N/AYesNoPayment Method*Select OneCredit Card via PayPalU.S. MailCredit Card Name Enter name on credit card if different from member name. First Last Applicant Profile: Canine InformationPlease provide the following information to help us get to know you better.Breeds Owned*Number of*Years in Border ColliesBorder Collies Currently OwnBorder Collie Litters Bred in Last 3 Years List the Border Collie rescue organization in which you are a member, or enter N/A.*Areas of Interest (Agility, conformation, herding, obedience, etc. – list all that apply.)*Titles (List highest title in each category which you have earned and number of titles at that level, UDX5 for example.)*Last Year*Competed in an AKC EventCompeted in any Canine Event Applicant Profile: Personal InformationOccupation*Special Skills*Club Activity*List areas of Club-related activity in which you would like to become involved.Committees*List Committees on which you would like to serve.Approved Judge*If you are an approved judge for any canine activity, list which activity and organization (ex, Herding/AKC), or enter N/A.NotesEnter any special notes needed.
