 | | United Belgian Shepherd Dog Association, Inc. | | |
| | | Renewal Form | | |
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It’s time again to renew your membership to UBSDA. We hope that you will continue to support this organization.
Membership dues for the year are due before January 1st of each year.
Dues received after January 1, must have a $5.00 late fee attached. Please complete the following requested information:
Name (s) __________________________________________________________________________________
Address _____________________________________________ City ___________________ State _________
Zip code _________________Country ____________________ Phone ________________________________
Email address __________________________________ Website address ______________________________
Varieties owned (please circle) G L M T Kennel name _______________________________________
UBSDA needs volunteers. List the most recent area you volunteered in and the date._____________________
___________________________________________________________________________________________
Please list an area in which you would like to volunteer for.
Committee: ___________________ National Show: _______________________ Other: ____________________
Check one: ( )Single Membership $37.00 ( ) Household Membership $52.00 ( )Junior Membership $15.00
Members residing outside of the United States --- enclose an additional $15.00 for postage.
All moneys must be payable in US funds.
( ) First class option for Beacon. Add $15.00.
Member signature ______________________________________________________ Date ____________________
Member signature ______________________________________________________Date ____________________
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You may take this opportunity to contribute to special UBSDA funds along with your renewal.
If you wish to make a memorial donation, include the name on the line below and designate to which fund it should be applied.
Memorial donations will be published in a special section of the Belgian Beacon. Thank you!
UBSDA General Fund: $ ____________ UBSDA Rescue: $_____________
Health Fund:$________________ UBSDA National Show: $ ___________
Memorial Donation: In memory of ______________________________________________________________
Apply to __________________________ fund.
Thank you,
Teri Alger, UBSDA Corresponding Secretary
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Received________________________________
Check #________________________________ | | | |
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