Online Membership Application

Please indicate if this is a new or renewal membership *
NewRenewal
Method of payment: *
If you wish to pay by PayPal please provide email below.
Adult Membership *A Family Membership for 1 adult and a child receives one vote. Anyone under 18 years old is not eligible to vote. Youth can show on a Family Membership however a Junior Membership is required to be eligible for Year End Awards.
Adult #1: First and Last Name
Adult #2: First and Last Name
Information Required *Street Address: City: State: Zip Code:
Information Optional: Telephone: Cell: Fax:
Email: Membership, News Blasts, Poll Votes and News Letter
Kennel Name (if applicable): If you would like to register your kennel name with MASCA please see separate application for this.
Blue Ribbon Breeder See Separate application for Blue Ribbon Breeder Listing for website $25 for new or $10 for renewal. Kennel Name Listing (Must also be current on file to have a listing on the website) Breeder Listing on Website $25
Please provide website address if you selected to be listed on MASCA Breeder page:
Junior Membership
Junior #1 Name, Date of Birth, Age
Junior #2 Name, Date of Birth, Age
Junior #3 Name, Date of Birth, Age
Junior #4 Name, Date of Birth, Age
Junior #5 Name, Date of Birth, Age
Junior #6 Name, Date of Birth, Age
By submitting this form you agree to Abide by MASCA Code Of Ethics. *
Code Of Ethics 2/5/2015
Please provide date of Application being filed. *

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