Please print out the following application, fill it out and mail to the address listed below. This is NOT an on-line form.

Name Telephone

Address
City State Zip
E-mail Kennel Name
 

Do you currently own any Shiloh Shepherds? Yes (please specify below) no
(Note: if you own more than two Shiloh Shepherds, please list details on back of this form)
Shiloh
#1

Registered Name
Date of Birth

Male
Female
Sire:
Dam: 		Breeder:
Shiloh
#2

Registered Name
Date of Birth

Male
Female
Sire:
Dam: 		Breeder:
Do you plan on purchasing another ISSR Registerd Shiloh Shepherd in the future? yes no
Do you plan on showing/breeding your Shiloh Shepherd if he/she has all the quality requirements? yes no

What other activities do you participate in with your Shiloh Shepherd? (check all that apply):

STM Agility Search & Rescue
Flyball Schutzhund Therapy
Herding Utility  
Obedience [ Novice or Open]  
Other (Please Describe):

Please state your past experience in showing, training and breeding:

 

Are you a member of the Shiloh Shepherd Dog Club of America (SSDCA)? yes no

If yes, Member Number: Number of years:

Note: All SSONE members MUST be members of the parent club, The Shiloh Shepherd Dog Club of America (SSDCA)
If asked, would you be willing to function in any particular office or any committee? yes no

Is there any service for the chapter that you are willing to perform? yes no

If so, please describe:
 

With my/our signature(s), I/We agree to abide by the Constitutin and By-Laws of the SSDCA, the Breeder's Code of Ethics and the Chapter's Policies & Procedures Handbook. All the information given above is correct to the best of my/our knowledge.

Signature: Date:
Signature: Date:

Type of Membership & Annual fee: Junior $10 Individual $15 Family $20
Total Payment Enclosed New Member Renewal
 

----FOR OFFICE USE ONLY----

DATE RECEIVED: AMOUNT PAID: SSONE MEMBER #:

RECEIVED BY: MEMEBERSHIP DATES: FROM: TO

PLEASE MAIL YOUR COMPLETED APPLICATION & PAYMENT TO:
SHEILA MASSE, SSONE PRESIDENT | 299 William Henry Rd | N. Scituate, RI 0285

top

last updated: 4/10/05