4 Corners Australian Shepherd Association
Membership Application
Name ____________________________________________________________________
Address __________________________________________________________________
___________________________________________________________________
Cell Phone __________________________ Home Phone ____________________________
Email Address ______________________________________________________________
How would you like us to update you about club activities? Email____ Mail____ Phone____
Australian Shepherd Club of America (ASCA® ) Membership # ________________________
What other dog clubs are you currently associated with? ______________________________
Areas of interest (please circle): Agility Aussie Rescue Conformation Flyball Frisbee
Herding Tracking Obedience Rally Treibball Other _______________
Membership Dues (check one): Individual $15 _____ Family $25 _____
Senior (55+) $10 _____ Junior (under 18) FREE _____
Additional Family Members: ___________________________________________________
In applying for membership, I and my family (if applicable) agree
to abide by the Articles of
Incorporation, Bylaws and all Rules and Regulations as set
forth by this club and its
parent club, the Australian
Shepherd Club of America.
Signature _______________________________________________ Date _____________
Please list any areas in which you have experience and/or would like to serve 4CASA:
* * * Please make check payable to
"Esther Ivey", the 4CASA Treasurer * * *
(Checks made out to
4CASA will be returned for replacement)
Print and Mail Application and Membership Dues to: 4CASA,
P.O. Box 1216, Bloomfield, NM 87413
(Annual fees are due June 30th. If joining
between Jan. 1 and June 30, Membership Dues are half the cost of a full
year)