(Please Print)
The GASC membership year is January 1 through December 31. New memberships voted on by October 1 or later are good through the following membership year.
List Each Adult Member’s Name: ______
Name: ______
Name:
List Name of Each Junior Member (less than 18 years of age):
Name: ______Birth date______Name: ______Birth date______
Address: ______
City/State/Zip: ______
Home Phone: ______Work / Cell Phone (Optional): ______
E-mail Address (Optional): ______
Are you a member of ASCA? ______If yes, membership number: ______
How many dogs do you own? ______What breeds? ______
______
Check all areas of interest:
____ Agility ____ Conformation ____ Flyball ____ Herding ____Obedience
____ Tracking ____ Other (specify) ______
Check one:
___ New “Candidate” Member* (Fees are the same as for membership types below; please check a type below) - To apply for full membership, requirements are 4 hours of service and attend 2 meetings, or 8 hours of service (upon Board approval) if can’t make the meetings. Can takepart in limited club activities, receive newsletters and all mail-outs, but will not have voting rights or full privileges, such as receiving year-end awards, submittingbrags, herding nights, play-day activities, etc., until voted into the Club at the general membership meeting following your fulfilling said requirements.
___ Renewal (check membership type below)
Check Type of Membership Desired:
___ Family* ($22.50) - includes two adults and their children under age 18 - 2 votes
Each additional adult family member wishing to join in the same household is $7.50
___ Individual* ($15) - includes one adult age 18 or older - 1 vote
___ Junior* ($7.50) - for individuals under 18 that are not included in a family membership - No voting rights
___ Subscription to Newsletter Only ($10) - No voting rights
* Includes a subscription to GASC Tell Me No Tails Newsletter
Any donation above the price of the annual membership is greatly appreciated and helps defray postage expenses.
I / We hereby agree to abide by the Constitution, Bylaws, Rules, Regulations, Code of Ethics, and Rules for Resolution of Disputes of both ASCA and The Gateway Australian Shepherd Club. (Membership shall be open to all persons who are in good standing with the Australian Shepherd Club of America and GASC.)
Signature of Each Adult Member Listed Above:
______Date: ______
______Date: ______
______Date: ______
Signature of Parent/Legal Guardian if this membership is for junior only:
______Date: ______
Send this completed form, along with your check made payable to Gateway ASC to:
Becky Androff, 3301 Putnam Ave, Belleville, IL 62226