Application For Membership for 2012

Complete the form (both sides), print and mail it (via the postal service) to the address at the top of this page. Enclose check or money order in U.S. funds.

Your name: ___________________________________________________

Spouse/significant other name can be added to membership listing but only one name is listed for breeder information and voting rights, so place this name first on the line above. If both want to be listed as breeders and have 2 votes, then a separate full membership must be filled out and paid for. Only the registered breeder signature is recognized on all litter and individual pup registration paperwork.)

Registered farm name (if applicable, meaning you have registered your farm name with the MSCA previously – see website for more information and for form to register a farm name. DO NOT fill this out if you have not previously registered your farm name with the MSCA.

Farm name: ______________________________________________________

Street address: ___________________________________________________

City: ____________________________________________________

State or Province _____________________________________________

Country and Zip Code or Country Code: ________________________________

Phone: _____________________________________________

E-mail: _____________________________________________

Would you like to be listed as a breeder? _______ yes; _______ no    

The MSCA maintains a formal breeders list as of 2012. This list will be sent to all inquiries to the club looking for a breeder. This service is included in the price of membership. MSCA will also maintain a website breeders listing for an annual fee of $10.00 – see information at the end of this form regarding this website listing.

FULL MEMBERSHIP: $35.00 per year pro-rated biannually; individual membership in U.S. Currency. An applicant must own a minimum of 1 purebred Maremma registered with the MSCA. Full members receive an extended, changeable Membership Directory entry. To be listed on the MSCA website as a breeder, full membership is required.

ASSOCIATE MEMBERSHIP: $18.00 per year pro-rated biannually. Individual membership in U.S. and Canada. All other countries $25.00 per year in U.S. currency. Associate members cannot vote and are not required to own a purebred Maremma. They will receive an entry in the Membership Directory (name, address, phone number, and registered farm name). Associate members may not be listed as a breeder with the MSCA.

***PLEASE NOTE that as of 1/1/12, fees for registering dogs and litters differ for nonmembers. Fees for dog and litter registrations remain at $10.00 for members. For nonmembers fees are $20.00 for dog registrations and $25.00 for litter registrations.

LIST OF ALL MAREMMAS YOU OWN; MSCA REGISTRATION NUMBER, REQUIRED ON THIS FORM (Full Membership requires minimum of one registered Maremma with the MSCA. If you have a dog registration pending with the MSCA, please list "pending" in Reg. No. field)

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male _____ female (check one)

MSCA registration number: ______________________________

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male or _____ female (check one)

MSCA registration number: ______________________________

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male or _____ female (check one)

MSCA registration number: ______________________________

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male or _____ female (check one)

MSCA registration number: ______________________________

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male or _____ female (check one)

MSCA registration number: ______________________________

Dog’s name: _____________________________________________________

Dog’s date of birth: __________ Sex: _____ male or _____ female (check one)

MSCA registration number: ______________________________

(if you need more, please print off and fill in another registration form (your name and dog information only) and staple to this form)

FULL MEMBERSHIP in MSCA places your name, address, phone number, information about your Maremmas (registration number, date of birth, sex) and your comments that you provide in the MSCA Membership Directory. You may change the contents of your Membership Directory listing at any time by submitting the revisions on this form. Membership directories are updated with every new or updated membership submission and are included in every packet of information or internet inquiry about breeders and owners sent out from the MSCA. New and renewing members will receive an updated membership directory (via e-mail as much as possible) when this form is submitted and membership paid for.

Directory entry (limit to 50 words): _________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Website URL:__________________________________________________________________

Check/fill in appropriate fields below:

Year of membership you are paying for: _______

Full membership ($35.00): ____ ($17.50 on or after July 1 of membership year) ____

Associate Membership, U.S. or Canada ($18.00) ____ ($9.00 on or after July 1) ____

Associate Member outside U.S. or Canada ($25.00) ____ $12.50 (on or after July 1) ____

***____ If you have already paid for a 2012 membership prior to receiving this application, , please check here

Breeder listing with the MSCA (website listing, annual fee $10.00): _________

TOTAL ENCLOSED: $__________

Remember to enclose check or money order in U.S. Funds payable to Maremma Sheepdog Club of America.

2011 ELECTION FOR 2012 BOARD OF DIRECTORS:

Are you interested in running for the following? Please check multiples if you would be willing to serve in either capacity and place number next to your choices indicating rank of preference. You must be a full member in good standing with the MSCA for 2012 to participate in this election, both as a candidate or as a voter. Per the bylaws, you must be a U.S. citizen to hold a board member position. All position terms are for 1 year.

President:

Vice President

Correspondence Secretary

Recording secretary

Treasurer

Board Member at Large

Board Member at Large

Board Member at Large

Board Member at Large