I/We wish to apply for membership into the

Old English Sheepdog Club of Central Florida.

To be eligible for household membership both applicants must reside at the same address.


Please print or type:


NAME:_________________________________________ 1st applicant

               Last                           First


NAME:_________________________________________ 2nd applicant

               Last                           First


ADDRESS: ________________________________________________________________


City: _________________________________ STATE: ________ZIP: ________________


Phone: _____________________________e-mail: _______________________________




_______ Conformation    _________ Herding    _________Obedience    _________Agility 


________ Pet (includes adoption of rescue as pet)   _______ Rescue work    _________Juniors


DUES:                                       DONATION $ ________________   

Individual              $ 12.00 ______

Household             $ 18.00 ______

Junior (10-18 yr.)  $ 10.00   Junior DOB: _____________


I agree to comply with the By-Laws and Code of Ethics of the Old English Sheepdog Club of Central Florida .

I have enclosed a payment in the amount of $ _____________US funds.


Signature: ____________________________________ (1st Applicant)


       ____________________________________ (2nd Applicant)


Date :       _________________     


This form and a signed Code of Ethics should be sent to:

Old English Sheepdog Club of Central Florida

   Membership Chairman: Linda Liljequist

     1517 Schalamar Creek Dr.

     Lakeland, Florida 33801