International White Collie Club ((Membership Application)) IWCC

INTERNATIONAL WHITE COLLIE CLUB
NEW MEMBER APPLICATION - 2011

Please let us know how you heard of us:     Our website     Internet      Member       Magazine
                  Other ____________________________

NAME(s):______________________________________________________________________________

ADDRESS:___________________________________________ CITY:____________________________

State/Province/Country:__________________________________ POSTAL/ZIP CODE_________________

PHONE: (           ) ______________________________   FAX: (             )____________________________

E-MAIL:_______________________________________________________________________________

Your Website:___________________________________________________________________________

Are you interested in serving the Club in an Official capacity?    _______YES   _______ NO
If, YES, please state office/committee you wish to serve & your experience/qualifications:
_________________________________________________________________________________________

_________________________________________________________________________________________

Circle all related to you as a Collie person:   a) owner    b) breeder    c) exhibitor     d) handler

e) other___________________________________________________________________________________

_________________________________________________________________________________________

Please check if you are a member of:

Collie Club of America__________ Collie Club of Canada __________ Other ___________________________
Local Collie Club Name _____________________________________________________________________________
International Affiliation_______________________________________________________________________________

Other Clubs: ______________________________________________________________________________________
Other Interests: ____________________________________________________________________________________
PLEASE LIST OTHER INFORMATION ON ANOTHER SHEET.
If you would like to send a short introduction
about yourself, please feel free to include one.

MEMBERSHIP YEAR:   JANUARY 1st – DECEMBER 31st
Dues received in the last quarter (Oct.-December) will be applied to following year’s membership.

MEMBERSHIP DUES: USA, CANADA, MEXICO US FUNDS ONLY – PAYABLE TO I.W.C.C
Canadians, please pay amount equal to present USA currency exchange.
___ Individual: $15.00   ___ Family: $20.00   ___ Junior: $5.00 (16 years & under w/parent(s) membership.

ALL OTHER COUNTRIES:   ____ Individual: $20.00    _____ Family: $25.00 Euros Accepted

I agree to abide by the Constitution, By-Laws & Code of Ethics of the
INTERNATIONAL WHITE COLLIE CLUB.
I (we) certify there are no past or present unresolved dog issues on record at time of my (our)
application(s). If elected to office, I (we) will serve said club as a whole and not abuse any office.

SIGNED: _________________________________________________DATE: ________________________

SIGNED: _________________________________________________DATE: ________________________

SPONSOR: _______________________________________________DATE: ________________________

Please print, complete and mail to the address at the bottom of the page:

Membership Chair: Jacqueline Young-Barikhan

Accepted ______ Rejected _____
21985 Trailways Lane
Lake forest, CA 92630                                                                    Date Received: ________________
(714) 612-1556
E-mail @ BellagioC@aol.com                                                            Dues Paid: ___________________