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 __________