New Membership Form 2019

BCSA New Member Application

Complete the form below to apply for BCSA Associate or Junior Membership. If you would like to be considered for full membership, please contact the Membership Chair for an application and sponsorship forms . Review all information carefully before pressing “Submit Application.” * = Required Information

Applicant Information
Name*
First Last
Household Name*
Enter N/A if individual membership.
Age*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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. No sponsor is necessary for an Associate membership per BCSA Policy.
First Last
Membership Information
Membership Type/Dues*
Please Agree to Accept Meeting Notices via email*
Agreement*
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*
By selecting "YES", I confirm that it has the same effect as my personal signature.
Household Signature*
Select N/A if Individual Membership. Household Membership: By selecting "YES," I confirm that it has the same effect as my personal signature.
Payment Method*
If you plan to pay by check, BEFORE YOU CLICK SUBMIT, please print this page now using your browser's PRINT option. Mail a copy of it, along with a check made payable to BCSA to New Member Application, c/o Adrian Smith, Treasurer, PO Box 940322, Simi Valley, CA 93094
Applicant Profile: Canine Information
Please provide the following information to help us get to know you better.
Breeds Owned*
Number of*
Years in Border Collies Border Collies Currently Own Border 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 Event Competed in any Canine Event
Applicant Profile: Personal Information
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.
Notes
Enter any special notes needed.

BCSA New Member Application

Applicant Information

Membership Information

Applicant Profile: Canine Information

Applicant Profile: Personal Information