Please copy and paste into a new e-mail 

or print and mail to the club secretary: secretary@acdrescueassociation.com. 

Australian Cattle Dog Rescue Association

Membership Application Form

_______  New Membership                                                                                                      Date  ______________________

_______  Renewal

______  Reinstate (Prior members who have not renewed for the current Club year)

_______  Donation Only

Type of Membership:  __ Regular ($1)                                                                                         Membership  __________

*A donation of $10 or more entitles a NON member inclusion in ACDRA@yahoogroups.com.                Donation   __________  

                                                                                                                                                 Amount Enclosed    __________

Name  ___________________________________________________________________________________________________

              Last                                                                                           First                                                                         Middle

Address  _________________________________________________________________________________________________

                  Street                                                                                     City                                                         State        Zip

Occupation  _____________________________   Kennel Name (if applicable) ___________________

Home Phone ____________  Work Phone ____________  E-mail address  ______________________

1) What attracted you to the Australian Cattle Dog?   ________________________________________________________

_____________________________________________________________________________________________________

2) What attracted you to Rescue?  _________________________________________________________________________

_____________________________________________________________________________________________________

3)  Do you presently own an Australian Cattle Dog?  __________  If yes, how long?  ________________

4)  Do you intend to breed your dog?  __________  If yes, are you aware of the genetic and hereditary problems present in the breed?  __________

5a)  Are you a member of the Bull Run Australian Cattle Dog Club?  __________

5b)  Are you a member of the North Atlantic Australian Cattle Dog Club?  __________

5c)  Are you a member of the Australian Cattle Dog Club of America?  __________

5d)  If a member, are you in good standing with the AKC?  __________

5e)  Please list any other dog clubs you belong to (past and present) and positions you have held  ___________________                     _____________________________________________________________________________________________________

6)  ACDRA is not a social club, it is a working club.  How do you plan to help? __________________________________

_____________________________________________________________________________________________________

Comments  ___________________________________________________________________________________________

SPONSORS

Please list two ACDRA sponsors.

SPONSOR #1  ___________               _________________________________________

SPONSOR #2  ______________               ______________________________________

I have read, understand and hereby agree to abide by the By-Laws of the Australian Cattle Dog Rescue Association.

Applicant Signature  _______________________________________________________________________

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