MEMBERSHIP APPLICATION Name(s):___________________________________________________________________ Address:____________________________________________________________________ City:___________________________________________Province/State________________ Country:________________________ Postal Code:_________________________________ Email:__________________________________________Phone#______________________

Type of Membership: Please Check one: New Member______ Membership Renewal_______ ________Single ($5.00/year, 1 vote for Canadian Resident over 18yrs only) ________Family Membership ($10.00/year, 2 votes Canadian Residents over 18yrs only) ________Add $10 for Kennel Listing on MASCAN web site/blog. (Breeder Members can fill out our Breeder Information Page 2. All information is kept strictly confidential and is optional, for membership registry only) Payment is in Canadian Funds and can be made by: (please check your method of payment) _________Cheque (made out to Monica Gaw and mailed to Lisa Moir with application) _________Email Transfer ([email protected]) _________Cash Membership forms may be scanned and emailed to [email protected] or mailed to: Lisa Moir, 11 Lorne Ave., Trenton, ON, K8V 5B1 Special Interests: ______Agility ______Obedience ______Rally-O _____Fly Ball ______Tracking ______Conformation ______Herding ______Scent Detection _____Disc/Freestyle Are you interested in working on club committees? ________Yes ________No As a member of MASCAN, I (we) agree to abide by the MASCAN Code of Ethics & Bylaws. Signed:_______________________________________ Date:___________________________ Signed:_______________________________________ Date:___________________________

MEMBERSHIP APPLICATION page 1 Jan 16.pdf

_________Cheque (made out to Monica Gaw and mailed to Lisa Moir with application). _________Email Transfer (Payments@MiniatureAmericanShepherd.ca) _________Cash. Membership forms may be scanned and emailed to [email protected] or mailed to: Lisa Moir, 11 Lorne Ave., Trenton, ON, K8V 5B1.

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