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BCSA MEMBERSHIP RENEWAL eAPPLICATION
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Complete the form below to renew your BCSA Membership.  Review all information carefully before pressing "Submit Renewal".   After you "Submit" your form, you will have the option of paying your dues with a credit card via PayPal or mailing your payment.  (R) = Required Information

RENEWAL EXCEPTION:  Memberships for those joining after 11/1/16 do not expire until 12/31/17. No renewal is due at this time for these memberships.

   
MEMBER INFORMATION
First Name:   (R)
Last Name:   (R)
Household Name:  
Age:   (R)
Address:   (R)
City:   (R)   
State:   (R)
Zip:   (R)
Best Telephone:   (R) 
E-mail:
(R)
Note: -- Members with an e-mail address will receive the annual Membership Roster via e-mail. 
-- Make certain the Membership Chair is notified if your e-mail address changes. 
-- Enter N/A to have the Roster mailed.
 
Payment Type:   (R)
Credit Card Name: Enter name on credit card if different from member name.
   
MEMBER PREFERENCES/SIGNATURE
Membership Type/Dues:    (R)
Meeting Notices:    (R)
Agreement:
(R)

By selecting "AGREE", I agree to comply with the Code of Ethics, to support the Constitution and Bylaws and to strive to fulfill the Mission and Vision of the Border Collie Society of America.

Applicant's Signature:
(R) By selecting "YES", I confirm that it has the same effect of my personal signature.
Household Signature:
(R) Select N/A if Individual Membership.  Household Membership: By selecting "YES", I confirm that it has the same effect of my personal signature.
Note: Enter any special notes needed.