FL Pan-Handlers ASC, INC.

Send Membership Application and dues to:
FL Pan-Handlers ASC, INC.
601 E. Burgess RD., #J-4
Pensacola, FL 32504

MEMBERSHIP APPLICATION

CHECK ONE

____ SINGLE......$15.00 ____FAMILY......$25.00 ____JUNIOR......$5.00
(Family membership includes Junior handlers living in the household under age 18)

Name(s):________________________________________________________

Address:________________________________________________________

City:_________________________ State:__________ Zip:____________

Phone:______________________ Email:_____________________________

Kennel Name:____________________________________________________

Are you an ASCA Member? ______No ______Yes #____________________

Main areas of interest:

___Herding ___Conformation ___Obedience ___Agility ___Tracking

___Other:________________________________________________________

I (WE) HEREBY APPLY FOR MEMBERSHIP IN THE FL Pan-Handlers ASC (FPHASC). MEMBERS AND NON-MEMBERS PARTICIPATING IN CLUB ACTIVITIES AGREE TO ABIDE BY AND UPHOLD THE CONSTITUTION, BY-LAWS, REGISTRY RULES, POLICIES, PROCEDURES, CODE OF ETHICS, AND DISPUTE RULES OF BOTH ASCA AND FPHASC. I AM (WE ARE) IN GOOD STANDING WITH THE AUSTRALIAN SHEPHERD CLUB OF AMERICA, INC.

Signature:_______________________________ Date:__________________

Signature:_______________________________ Date:__________________

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