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UNITED STATES AUSTRALIAN ShEphERD ASSOCIATION (USASA)
2010 MEMBERShIp AppLICATION
 Membership Renewal  New Member Application
Please fill out only the top portion of this form when applying for subscribing/members status. Fill out the entire form when applying for membership.This application is accepted subject to the approval of the membership and the Board of Directors of USASA.The Board review process for applicants whose membership has been protested in writing, referred to in Article 1, Section 3 of the USASA Bylaws, will include notification of the applicant as to the nature of the complaint and the identity of the complainant. Applicants will be given 30 days from the date of notification by the USASA Board to refute the com- plaint, at which time all information will be reviewed and the vote, as prescribed in the Bylaws, will be taken.The applicant and the protesting club member will be notified in writing of the Board’s decision. If not approved there is no obligation on the part of the Association to disclose the reasons for its decision. Your signature on this form signifies that you understand and agree to the above statement.The IRS has stated that dues are not normally deductible. Please consult your tax adviser if you have questions about the tax status of your dues payment.
NAME ADDRESS
Would you like to receive the USASA newsletter via e-mail?  Yes  No
I agree to abide by the Constitution, By-laws, and the Code of Ethics of the United States Australian Shepherd Association and I am in good standing with the American Kennel Club.
AREAS OF INTEREST:  Pet
 Tracking
PHONE ( )
 Breeding  Obedience
EMAIL
 Conformation  Herding
 Search & Rescue  Aussie Rescue
 Handling  Ring Stewarding Please give a brief history of your dog related activities (attach additional sheets if necessary):
 Agility  Judging
Are you interested in an Affiliate Club  Yes  No Are you active in any area:  Yes  No Number of dogs:
Signature of Applicant Kennel Name
Memberships are renewed yearly. Payment must accompany application. Make check (in US funds only) payable to USASA.
Signature of Co-Applicant
Membership Dues
(includes USASA Newsletter)
Journal Subscriptions
 Subscriber (Journal only, 3rd class)  First Class
 Subscriber Canadian (Journal only)  Subscriber Foreign (Journal only)
$40.00 $50.00 $55.00 $75.00
Send to:
Lisa Leipold
806 Cleveland Ave., Altoona, pA 16602
(814) 944-3055 • Email: aussies4me@verizon.net
 Individual Member (Journal, 1 vote)
 Dual Member (Journal, 2 votes)
 Canadian Member (Journal, no vate)
 Foreign Member (Journal, no vote)
 Junior (no Journal, Note: parent must be a member)
$60.00 $75.00 $95.00
$110.00
FOR OFFICE USE ONLY Date received:
Date Approved:
Date Membership Sent: Other:
processed by:
AUSTRALIAN JOURNAL SHEPHERD
P. O. Box 240 • Waynesboro, GA 30830 • 706-437-1017 • terry@dickey.com
Yearly rate: $40 (for 1st Class Mail add $15); $55 Canadian; $75 Foreign subscriptions (all in US funds, payable to US bank) Make checks payable to:The Australian Shepherd Journal.
Credit card payment can be made at www.australianshepherds.org.
 Renewal Date
Name Address Kennel Name: City
 New Subscription Phone ( )
 Gift (Gift Card Available) E-Mail:
State
Fax: ( )
Zip+4
November/December 2009
The Australian Shepherd Journal 39