Australian Shepherd Club of Southern California, Inc. (ASCSC,Inc.)

For administration use only
Application Received on:
______Check #______
Added to Roster______
Introduction mailed______

Application for Membership

(Membership is subject to ASCSC, Inc. Board Approval)

Name(s)______Phone______

Address______Phone______

City______State___ZIP______Email______

Check 0ne______Renewal______New applicant(s)ASCA #______

Optional

2011Dues are $20 January to December. New member applications after June 30 are $10.

What are your areas of interest with your dog/s:

_____Conformation_____Obedience_____Agility_____Working/Herding_____Other_____

How many dogs do you have?_____What breed/s are they?______

If you would like to get involved in club activities: What types of things would you like to do?

The Australian Shepherd Club of Southern California has Conformation Shows, Obedience Trials, Agility Trials, and Working Trials. The club needs trophies (club members have made beautiful handmade items), trailers towed, equipment moved, etc. There is something for every one. What would you like to do? ______

I agree to hold harmless the Australian Shepherd Club of Southern California, Inc (ASCSC,Inc.). Its members, officers, directors, agents, volunteers, the owner/s or lessee/s of any premises used for ASCSC, Inc. activities, or training classes, sanctioning organizations, sponsors of any event, or any employee of the aforementioned parties from any claim for loss, or injury which may be alleged to have been caused directly or, indirectly to any person, or thing by the act of my dog/s while in or upon the aforementioned premises, or grounds, and I personally assume all responsibility for any such claim. I further agree to hold the aforementioned parties harmless from any claim for loss, damage, or injury of my dog/s by: disappearance, theft, injury, death, or otherwise, whether caused or alleged to be caused by the negligence of ASCSC, Inc. or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes.

I hereby assume the sole responsibility for and agree to indemnify, and save the aforementioned parties harmless from all loss and expenses (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injury, including death at any time resulting there from, sustained by any person including myself on or account of damage to property, arising out of or in consequence of my participations in any ASCSC, Inc. event; howsoever such injury, death or damage to property may be caused, and whether or not the same may have been caused of may have been alleged to have been caused by negligence of the aforementioned parties or any other person. I agree to assume all risk for injury or death to either my dog/s or myself caused by participation in ASCSC, Inc. events/activities.

By submitting this completed application, I hereby certify that I will abide by the Articles of Incorporation, Bylaws, Rules, Regulations, Code of Ethics, and Dispute Rules of both the Australian Shepherd Club of America (ASCA), and ASCSC, Inc.

Signature Member #1 Date Signature Member #2 Date

Any questions? Call Paul Kirk 818-886-5467 or email
Please mail completed application along with your payment to:
Paul Kirk 9358 Wystone Avenue, Northridge, CA 91324