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MEMBERSHIP APPLICATION


 
 
 
 

APPLICATION FOR WKA (Working Kelpies of America) MEMBERSHIP
 
Name(s): _____________________________   Email: ________________________
 
Address: _____________________________   Phone: _______________________
 
City: _________________________ State: _________________ Zip: _______________

 

Occupation or Business: ______________________________________________________________
 
What prompted your interest in herding? _________________________________________________
 
What breed(s) of dog(s): ______________________________________________________________
 
Number of dogs presently owned: _______ How long have you been into dogs? _________________
 
What is your experience in dogs? _______________________________________________________
 
(Circle)                            Show                    Obedience         Herding               Tracking              Breeding                                            Other*
*Explain___________________________________________________________________________
 
Do you have any livestock experience? __________ Do you own any livestock? _________________
 
Affiliations with other breed and dog clubs: _______________________________________________
 
Why do you wish to join WKA? ________________________________________________________
__________________________________________________________________________________
 
Are you interested in actively supporting WKA? _______ If so, in what areas? ___________________
 
 
 
 
Please make out your check to Working Kelpies of America for:
Individual Membership $10.00 Family Membership $15.00 Lifetime 150.00
 
 
Send Completed Application to Working Kelpies of America HC 66 Box 140, Mountainair, NM 87036
 
Sponsored by: _____________________________ Sponsored by: ____________________________
Signature: _______________________________________  Date: ________
How long you known the applicant? _______ How long have you known the applicant? ______
s/her/their interest in herding? _______ What is his/her/their interest in herding? _______
 
Signature _________________________________ Signature ________________________________
Submission Date __________       Board Action Date __________                                                                        Approved/Rejected Date________
Payment amount __________         Check number           __________

Membership Form
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