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Prairie Australian Shepherd Enthusiasts Member Application Form

New Member____                 Renewal____



Name(s):_________________________________________________
Address:__________________________________________________  
Phone Number: Home:______________ Business:________________                      
Email Address:___________________________________________

    Number of Dogs Owner (Breed and Name):
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________

    Dog Related Interests (ie: Agility, Conformation, Breeding etc):
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________



Send all membership forms to:  

Kelly Campbell
2 Ellison Cres.
Regina, Saskatchewan                            
S4R 4V3  

Costs
Single : $20.00            Family  $30.00