Southern Louisiana Australian Shepherd Club
21146 Dusty Lane
Hammond, La 70401
(985) 542-4993
goldring@i-55.com
MEMBERSHIP APPLICATION
Please provide the following information:
Name:______________________________________ Spouse:_____________________
No. of Children in household:___________________
No. of pets in household: Dogs:__________ Livestock___________ Other:__________
Home Phone:( )___________________ Work/Cell Phone: ( )________________
E-Mail/Website Address:___________________________________________________
___________________________________________________
ASCA Membership #: ___________________________________
Have you ever been a member of any other club? Yes No circle one
If yes, What clubs and Where?______________________________________________
_______________________________________________________________________
How long have you been a member of this club(s)?_______________________________
Are you presently under suspension by ASCA, USASA, or AKC? __________________
**Suspension by one of these clubs constitutes automatic suspension from the
Southern Louisiana Australian Shepherd Club until reinstatement**
I am interested in the following: (Please check all that apply)
______Agility _______Community Education (seminars)
______Herding _______Pet Therapy
______Conformation _______Breeding
______Obedience _______Frisbee/Flyball
______Tracking ______ Rescue (fostering, donating time, etc)
______Holding an office in the Club _______other
If you checked Other, Please explain________________________________________
I understand that upon acceptance of my dues in the amount of $15.00, I am granted
Membership into the Southern Louisiana Australian Shepherd Club. Such membership consists of participation in various events designed to promote responsible ownership,
Training and breeding of the Australian Shepherd breed as well as participation in various dog sports for which the breed is qualified Membership extends for the calendar
Year of January 1st through December 31st. Annual dues are due by January 31st to avoid lapse of membership.
I pledge to abide by the Bylaws of the Club and adhere to the Code of Ethics.
**Receipt of payment for dues and a current Membership list will be issued to member upon acceptance**
