MEMBERSHIP FORM
Individual Membership  $20.00
Family Membership       $35.00

New Member

Renewal
Year ____________

First Name
 		Last Name
 Mailing Address:
Prov. / State Postal / Zip Code
email:

Home phone: 		BusinesS

BREED OF DOG
RACE DU CHIEN

 MALE FEMALE
NEUTERED
NAME OF DOG
NOM DU CHIEN

AGE:

CHECK THE INTEREST THAT APPLY
HERDING DUCKS
HERDING SHEEP
HERDING STOCK

TRAINING
CKC TRIALS
OTHER TRIALS
ASSISTING AT UHERDER EVENTS



 

I Understand that: My membership entitles me to special rates at trials and seminars.
I agree to show good sportsmanship and to treat my dog (s) humanely at all times.

Signature:

Date:

Mailing Address

U Herders Club
c/o Bev Hurst
6950 Cty Rd # 10
Vankleek Hill, Ontario
K0B1R0

PAYMENT

CHEQUE
CASH    

Date Rec'd _____________