________________________________________________________________ International Indian Dog Owners & Breeders Association ---- Membership Form --- FULL MEMBERSHIP  $25.00 -Includes husband, wife & children under 18. or AFICIONADO MEMBERSHIP  $20.00-- May include same family members as above. Please fill out the following information: Name: ___________________________________________________________ American Indian Dog(s) name: _________________________________________ Registration #(s) __________________________________________________ Address: _________________________________________________________ City, State: _______________________________________________________ Zip Code: _________________________________________________________ Phone/Fax: ________________________________________________________ Email or Web Address: _______________________________________________ Number of People in this membership. Adults _______ Juniors _______ Junior names and birthdates (optional)________________________________ __________________________________________________________________ Please check your interests below:  Training/obedience  Native American Pow Wows  Fund raising  Therapy/Service Dog work  Promotion/Merchandising  Research/Education  Exhibitions  Newsletter Contributor  Committees Please answer the following questions: 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? ________________________ Other organizations (animal related) that I am a member of: _________________________ _________________________ _________________________ _________________________ Enclosed is my check for $ _________ in US Funds made payable to IIDOBA Note: There will be a $20.00 processing fee on any returned checks 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 . Send to: Cyndi Sixkiller 303 N. 50th Ave Longview, WA 98632 email address: luna6killer@earthlink.net IIDOBA use only_____________________________________________________ ___/___/___ Interviewed by: ____________ ____________