Membership
Contact:
Torri Spierling
P.O. Box 76
Johannesburg, MI 49751
Membership Application - One Year Membership
Name: ______________________________________________
Telephone Number: (______)-______-__________
Address: ______________________________________________________________________________________________________________
City: ___________________________________________
State: __________________ Zip: ____________________
Email: __________________________________________
GETTING TO KNOW YOUR DOG
Kennel Name: _____________________________________ ( if you are a breeder)
Do you own a Shiloh? ______________ If yes, please indicate number:
DOG __________________ BITCH _________________
Registered Name: ________________________________________________
Date of birth: _____________________
Sire: _____________________________
Dam: ______________________________________________
From whom did you purchase your Shiloh?
____________________________________________________________
Do you plan on purchasing another Shiloh in the future? ____________________________________________________________
Do you plan on showing/breeding your Shiloh if he/she has all the quality requirements? _______________________________________
What other activities do you participate in with your Shiloh? (circle all that apply)
Agility Flyball Search and Rescue Obedience Novice Open Utility
Therapy Schutzhund Herding
Other (please describe)_______________________________
Please state your past experience in showing/training/breeding below.
Are you a member of the SSDCA? _____________For how many years?__________
SSDCA Membership #___________________
GETTING TO KNOW YOU
Are you: Married Single (please circle)
Do you have children? Yes No (please circle)
If yes, please list their names & ages: _______________ _______________ ________________
________________ _______________ ________________
What led your family to the choose the Shiloh Shepherd?
What kinds of activities would you like to see the MSSC chapter sponsor?
All MSSC members must be members of the parent club, the Shiloh Shepherd Dog Club of America, Inc.
If asked, would you be willing to function in any particular office or any committee, or is there any service for the chapter that you would like to perform?
___________________________________________________________
With my signature,
___________________________________________________________ I agree to abide by the Constitution and by-laws of the SSDCA and the Breeders Code of Ethics. All the information given above is correct to the best
of my knowledge.
Please include a payment of:
$10.00-Junior Member
This membership is if you do not own a Shiloh. Should you purchase a Shiloh in the future you will need to upgrade to a Family membership.
$20.00- Family Member
For Office Use Only
Date Received: _______________________ Membership Dates:
Amount Paid: ________________________ From: ________/_________/_________
MSSC Membership # __________________
To: ________/_________/_________
Torri Spierling
P.O. Box 76
Johannesburg, MI 49751
Membership Application - One Year Membership
Name: ______________________________________________
Telephone Number: (______)-______-__________
Address: ______________________________________________________________________________________________________________
City: ___________________________________________
State: __________________ Zip: ____________________
Email: __________________________________________
GETTING TO KNOW YOUR DOG
Kennel Name: _____________________________________ ( if you are a breeder)
Do you own a Shiloh? ______________ If yes, please indicate number:
DOG __________________ BITCH _________________
Registered Name: ________________________________________________
Date of birth: _____________________
Sire: _____________________________
Dam: ______________________________________________
From whom did you purchase your Shiloh?
____________________________________________________________
Do you plan on purchasing another Shiloh in the future? ____________________________________________________________
Do you plan on showing/breeding your Shiloh if he/she has all the quality requirements? _______________________________________
What other activities do you participate in with your Shiloh? (circle all that apply)
Agility Flyball Search and Rescue Obedience Novice Open Utility
Therapy Schutzhund Herding
Other (please describe)_______________________________
Please state your past experience in showing/training/breeding below.
Are you a member of the SSDCA? _____________For how many years?__________
SSDCA Membership #___________________
GETTING TO KNOW YOU
Are you: Married Single (please circle)
Do you have children? Yes No (please circle)
If yes, please list their names & ages: _______________ _______________ ________________
________________ _______________ ________________
What led your family to the choose the Shiloh Shepherd?
What kinds of activities would you like to see the MSSC chapter sponsor?
All MSSC members must be members of the parent club, the Shiloh Shepherd Dog Club of America, Inc.
If asked, would you be willing to function in any particular office or any committee, or is there any service for the chapter that you would like to perform?
___________________________________________________________
With my signature,
___________________________________________________________ I agree to abide by the Constitution and by-laws of the SSDCA and the Breeders Code of Ethics. All the information given above is correct to the best
of my knowledge.
Please include a payment of:
$10.00-Junior Member
This membership is if you do not own a Shiloh. Should you purchase a Shiloh in the future you will need to upgrade to a Family membership.
$20.00- Family Member
For Office Use Only
Date Received: _______________________ Membership Dates:
Amount Paid: ________________________ From: ________/_________/_________
MSSC Membership # __________________
To: ________/_________/_________