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