PUGET SOUND HERDING GROUP ASSOCIATION
New Membership Application
Membership applications will not be accepted with incomplete information.
Date: ____________________
Applicants under 18 years of age must have a parent’s signature on application. Use back if needed.
Name: _______________________________________________ E-Mail: ______________________________________
Mailing Address: _______________________________________City: ___________________________State: ________
Zip:
_____________
Telephone: ________________________
Name: _______________________________ E-Mail: _______________________________ Telephone: _____________
Name: _______________________________ E-Mail: _______________________________ Telephone: _____________
I/we, the above named, do hereby apply for membership in the Puget Sound Herding Group Association (P.S.H.G.A.) and
have enclosed dues for the year. I/we agree to abide by the Constitution and By-Laws of the P.S.H.G.A. and the American
Kennel Club.
Dues: Individual $25 _______
members) _______
Family $25 plus $10 each additional family member at the same address (maximum 3
Associate (non-voting) $15 __________ Junior Free__
____ I wish to receive communications by e-mail to the address listed above. (you will not receive a paper copy if you
make this selection)
____ I prefer to receive a paper copy of all communication
Signature: ____________________________________ Signature: _______________________________
Signature: ____________________________________
Two sponsors (existing PSHGA members) are required:
Sponsor #1 Name: ______________________________________Signature: ____________________________________
Sponsor #2 Name: ______________________________________Signature: ____________________________________
Submit completed application and dues to:
Anna Pearson, Secretary
18624 40th Place NE, Snohomish, WA 98290-9623
For Administrative Use Only:
Date received: ____________ Dues paid: ______________ Check #: ____________ Member #: _______________
1st Reading: _______________ Date of Vote: ________________ Action (Accepted/Denied) _______
PUGET SOUND HERDING GROUP ASSOCIATION
New Membership Application - Page 2
Name: _________________________________________________________________
Member #: __________
Name: _________________________________________________________________
Member #: __________
Name: _________________________________________________________________
Member #: __________
(Member number will be issued upon application acceptance)
Tell us about yourself:
Breed or Breeds owned: _______________________________________________________________
Check all areas that apply:
Exhibitor: ___ Conformation ___ Obedience ___ Rally Obedience ___ Agility ___ Herding ___ Tracking ___ Juniors
Judge:
___ Conformation ___ Obedience ___ Rally Obedience ___ Agility ___ Herding ___ Tracking ___ Juniors
Instructor: ___ Conformation ___ Obedience ___ Rally Obedience ___ Agility ___ Herding ___ Tracking ___ Juniors
Breeders:
Indicate the number of litters whelped within the past THREE years: _________
Areas of interest of committees on which you would like to serve:
___Breed Referral ___ Community Service ___ Education Programs ___ Fund Raising Activities ___ Hospitality
___ Match/Show Organization ___Performance Events ___ Publicity ___ Social Events ___ Trophies & Awards
___ Other: ____________________________________________
Do you have any special skills or talents that may be of benefit to the club? Photographer, artist, writer, computer skills,
etc. If so, please list:
________________________________________________________________________________________________
_________________________________________________________________________________________________