BCSA MEMBERSHIP APPLICATION/PROFILE - NEW
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To apply for membership, enter your information in the fields below and select the "print" option on your browser.  If you choose to hand print your application, please make certain all information is legible.  Thank you.

Please sign and mail the application, along with your membership fee, to Kathy Sours, BCSA Membership Chair, 3821 W Charter Oak Road, Peoria, IL 61615.  Your sponsor must complete and mail the Sponsorship Form in order for your application to be processed.


APPLICANT INFORMATION:  
Applicant Name:
Applicant Name
(if household):
Age:  
Address:
City/State/Zip:
Contact Info:
Telephone --
E-Mail
Re-enter E-mail:
Your sponsor:
Each application must be sponsored by a BCSA member in good standing and a Sponsorship Form submitted.
   

Membership Type/Dues:

  (Click here for Affiliate Club Membership Application)
Note: Memberships must be renewed annually.  Juniors must be age 10 to less than 18 years and are non-voting members.

Meeting Notices
(check one):
YES Send BCSA meeting notifications via e-mail.
NO Send BCSA meeting notifications via US mail.
   
I agree to: Comply with the attached Code of Ethics of the Border Collie Society of America. To support the Constitution and Bylaws of the Border Collie Society of America. To strive to fulfill the Mission and Vision of the Border Collie Society of America.

Applicant's Signature: ____________________________________________________

Applicant's Signature (if household): _________________________________________

APPLICANT PROFILE: Please provide the following information to help us get to know you better.

Canine Information:

Breeds owned:

Number of years in Border Collies:    Current Number of Border Collies:

Number of Border Collies litters bred in the past three years:

Areas of Interest (Agility conformation, herding, obedience, etc. - list all that apply.)

Titles (list highest title in each category and number of titles at that level, OTCh-3 for example):
Year you last competed in an AKC event: any canine event:

Personal Information:
Current occupation:
Special Skills:

Areas of Club related activity in which you would like to become involved:

Committees on which you would like to serve:

Are you an approved judge for any canine activity?

If yes, which activity and which organization? (Herding - AKC for example.)

Are you a member of any Border Collie rescue organization?

If yes, list organization:
 

(BCSA Use: Rec'd: ____________  Board: ____________  Approved: _____________)

Form Updated 02.28.2011