German Shepherd Dog Club of America
Working Dog Association
GSDCA-WDA Membership Entry Form
Check one:
Applying for
new membership
Applying for
renewal
Member ID: (renewals only!)
First Name:
Last Name:
E-Mail Address:
Street Address:
City:
State:
N\A
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
Phone Number:
GSDCA-WDA Region:
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
What's my Region?
Please check all that apply:
I belong to the following GSDCA-WDA Member Club:
I would like to contribute the following amount to the World Team Fund:
(Example: 150.60)
This is America's team that will represent the United States at the
World Union of German Shepherd dog Clubs this year.
I do not wish to receive club new and announcements via email
I agree to the following GSDCA-WDA membership terms and conditions:
GSDCA-WDA membership Terms and Conditions
Membership Type Information
*** From July 1st through November 15th, Individual, Family, and Junior ***
*** memberships are prorated - reduced by 50% for last 6 months of the year. ***
Individual Membership: $66 (18 years of age or older)
Family Membership: $90 (18 years of age or older; all must reside at same address)
Junior Membership: $28 (10 thru 18 years)
Lifetime Membership: $2500 (18 years of age or older)
List additional family members below.
First Family Member's First Name:
First Family Member's Last Name:
First Family Member's Phone:
First Family Member's Email:
Second Family Member's First Name:
Second Family Member's Last Name:
Second Family Member's Phone:
Second Family Member's Email:
Third Family Member's First Name:
Third Family Member's Last Name:
Third Family Member's Phone:
Third Family Member's Email
All new membership applicants
must be endorsed by two members in good standing with
the GSDCA-WDA:
Sponsor's Name: (for new members only!)
Sponsor's Name: (for new members only!)
Credit Card Information
Total Membership Purchase:
Card Holder Name:
Credit Card Number (no spaces):
Expiration Month:
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Year:
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
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