APPLICATION TO BECOME A SERVICE DOGS OF AMERICA AFFILIATED CLUB
Service Dogs of America is affiliated with the United Kennel Club
We the under sign, being members in good standing with Service Dogs Of America (SDA), do hereby petition for associated club status with SDA. We further agree to abide by the Rules and Governing Authority of Service Dogs of America.
NEW [ ] Renewal [ ]
The legal name of this club will be known as: ________________________________________________________________
Name of contact person:________________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ___________________________________ State: ________________________________ Zip code: _________
Telephone: ______________________________ Email: __________________________________________________
Signature of President: _____________________________________________________________________________
Address: ________________________________________________________________________________________
City: ____________________________________ State: ________________________________ Zip code: _________
Telephone: _______________________________ Email: _________________________________________________
Signature of Vice President: _________________________________________________________________________
Address: ________________________________________________________________________________________
City: _____________________________________ State: _______________________________ Zip code: _________
Telephone: _____________________________ Email: ___________________________________________________
Signature of Treasurer: _____________________________________________________________________________
Address: _________________________________________________________________________________________
City: _____________________________________ State: ________________________________ Zip code: _________
Telephone: ______________________________ Email: ____________________________________________________
Signature of Secretary: _______________________________________________________________________________
Address: __________________________________________________________________________________________
City: _____________________________________ State: ___________________________________ Zip code: _______
Telephone: _______________________________ Email: ___________________________________________________
Mail to:
SDA Club Membership
Bill Seltzer (217)546-1790
3709 Tozer Rd.
Springfield, IL 62707
Make checks payable to: Service Dogs of America for $150.00