FULL MEMBERSHIP
Includes husband, wife
& children under 18 years.
AFICIONADO MEMBERSHIP
May include same family
members as above.
$20.00
| Member's name: | |
| American Indian Dog(s) name: | |
|
Registration #(s) |
|
| Address: | |
| City, State: | |
| Zip Code: | |
| Phone/Fax: | |
| Email or Web Address: |
Note: Membership is to be paid on or before January 1st of each year. Those members who join after October 1 will be automatically extended through the next year.
Number of People in this membership.
_______ Juniors _______ Adults
Junior names and birthdates (optional)
___________________________
___________________________
| Training/obedience | |
|
Native American Pow Wows |
|
| Fund raising | |
| Therapy/Service Dog work | |
| Promotion/Merchandising | |
| Research/Education | |
| Exhibitions | |
| Newsletter Contributor | |
| Committees |
If not already an owner, do you plan to purchase an AID in the future? __________________________
If so, when? __________________________
How many other dogs do you own? __________________________
__________________________
Enclosed is my check
for $ _________ in US
Funds made payable to the IIDOBA
Note: There will be a $20.00 processing fee on any returned checks
Other organizations (animal related that I am a member of:
_________________________
_________________________
_________________________
_________________________
Send to:
Kim LaFlamme
3600 Lakeshore Drive
Selma, Oregon 97538
(541) 597-2871
laflamme@earthlink.net
IIDOBA use only
|
Interviewed by: |
