BCSA New Member Application - Associate/Junior Complete the form below to apply for BCSA Membership. If you would like to be considered for full membership, please make sure a sponsorship form is submitted in addition to this form. Review all information carefully before pressing “Submit Application.” * = Required Information Applicant Information - Associate/Junior MembershipName* First Last Age*18 or over17 or underAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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. Membership InformationMembership Type/Dues*$40 – Associate$50 - Single$60 - Household$15 – JuniorPlease Agree to Accept Meeting Notices via email*Yes, send BCSA meeting notifications via emailAgreement*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. 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/AYesNoApplicant 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 YearsList 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 EventApplicant Profile: Personal InformationPlease tell us about about your experience with Border Collies, AKC dog sports, and other areas of interest related to dog training, health, or rescue.Occupation*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.
