APPLICATION FOR MEMBERSHIP

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:_________________________________________ 1^st applicant

               Last                           First

NAME:_________________________________________ 2^nd applicant

               Last                           First

ADDRESS: ________________________________________________________________

City: _________________________________ STATE: ________ZIP: ________________

Phone: _____________________________e-mail: _______________________________

INTERESTS:

_______ 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: ____________________________________ (1^st Applicant)

       ____________________________________ (2^nd 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