ASA Membership Application Form

This is a form for submitting a new application to the ASA for membership.

Date*

Name*

First Last

Spouse or Partner's Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone for Contact*

Email*

Do you hope to breed or be a stud owner?*

Will you exhibit or train your Stabyhoun for:

Obedience

Rally

Agility

Hunting

Therapy Work

Scenting/ Barn Hunt

Conformation

Are you a licensed Judge? If so, what organization?

Other dog clubs to which you belong and offices held:

The Ameri-Can Stabyhoun Association has no paid staff and is run entirely by member volunteers. If accepted for membership in the ASA, I would be willing to volunteer:

Yes

Perhaps occassionally

My special interest and skills are:

Would you like your contact information to appear in the “Membership Directory” which appears in the “Members Only” section of the ASA website? It will assist other Staby owners close by to get in touch with you for gatherings and play dates! Please indicate:*

YES

Your Stabyhoun Info

If you do not yet own a Staby, please leave this blank and send the information below to the ASA Membership Chairman when you have received your pedigrees, etc. If you have more Stabyhouns, please notify us separately.

Dog 1 - Registered Name

Call name

Date of Birth

Microchip or Tattoo Number of Dog

Sex of Dog

Male Intact

Male Neutered

Female Intact

Female Spayed

Color of Dog

Black/ White

Black Roan

Brown/ White

Tri-Color

Breeder's Name

AKC Registration Number

FCPR Registration Number

Foreign Registration Number

Sire Name and Registration Number

Dam Name and Registration Number

If more than one Staby, please send us the information in an email to: Membership@stabyhouns.org. Thank you.

Choice of term for membership*

Payment Method*

Membership year runs from July 1 to June 30. All memberships approved on or after April 1 will be applied for the balance of the current and the following year. You will be redirected to the PayPal site to pay. If you prefer to send the ASA a check, the address: Ameri-Can Stabyhoun Association c/o Phil Frey, Treasurer 1161 Kneese Road, Fredericksburg, TX 78624

PLEASE NOTE THAT MEMBERSHIP IS NOT AUTOMATIC AND IS DETERMINED AT THE DISCRETION OF THE BOARD. If for any reason your membership application is denied, we will refund your application fee.

Name

This field is for validation purposes and should be left unchanged.