North American Shepherd Association (NASA) Membership Application

Please check one: New Membership Renewal

Please print the following:

Name: __________________________________________________________________________

Name of 2^nd Family Member: _________________________________________________________

Address: ________________________________________________________________________

City,State,Zip: ____________________________________________________________________

Email: ___________________________________________________________________________

Phone: ________________________________ Cellphone: _________________________________

What are your interests? Breeding/Genetics, Conformation, Obedience, Working/Herding, Agility,

Flyball, Search & Rescue, Disc Dog (Frisbee), Other: ____________________________________________

Would you like to be involved in the club? Fundraising, Serve on Committees, Help with Events (Conformation, Herding, Any), I would like to help but not sure how.

As a member(s) of NASA, I (we), the undersigned, agree to promote/participate only in activities and behavior that will benefit the common good of the North American Shepherd. I (we) also agree to abide by the NASA Bylaws and Code of Ethics.

Signature: _________________________________________________, Date: ________________

Signature: _________________________________________________, Date: ________________

Membership fees are due on October 1^st each year:

One family member: $15.00/year Two family members (2 votes): $20.00/year

For new members please follow this fee schedule for the 1^st year:

Joining October 1^st thru March 31^st (renew the following Oct 1^st) :

One family member: $15.00/year Two family members (2 votes): $20.00/year

Joining April 1^st thru September 30^th (renew the following Oct 1^st):

One family member: $7.50/6 mon Two family members (2 votes): $10.00/6 mon

Enclose check or money order payable in US dollars to: NASA (A $25.00 fee will be charged for returned checks). Please mail this completed form and dues to:

Sarah Seefeldt, N8380 North St., Ixonia, WI 53036

Board approved: date