MAMASC Membership Application
Mid America Miniature American Shepherd Club
(MAMASC) Membership Application
Please check one: New Membership Renewal (current MAMASC#)________________
Please print the following:
Name: _____________________________ MASCUSA Membership #__________________
Additional Family Member(s):____________________ MASCUSA Membership #___________
Name of Junior(s) and age________________________________________________________
Address: ________________________________________________________________________
City, State, Zip: ___________________________________________________________________
Email: ___________________________________________________________________________
Phone: ________________________________ Cellphone: _________________________________
**NOTE: Only members of the MAMASC Board of Directors are required to be members of MASCUSA.
What are your interests? Breeding/Genetics, Conformation, Obedience, Working/Herding, Agility,
Flyball, Search & Rescue, Disc Dog (Frisbee), Rally, Other: Please list other interest
Would you like to be involved in the club? Fundraising, Serve on Committees, Help with Events (Seminars, Conformation, Herding, Play days, Any), I would like to help but not sure how.
As a member(s) of a MASCUSA Affiliate Club, I (we), the undersigned, agree to promote/participate only in activities and behavior that will benefit the common good of the Miniature American Shepherd. I (we) also agree to abide by the MASCUSA Registry Rules and Regulations, Bylaws and Code of Ethics.
Signature: _________________________________________________, Date: ________________
Signature: _________________________________________________, Date: ________________
Membership Dues: One family member: $10.00/year $20.00/2 years $25.00/3 years
Family membership (2 adults): $15.00/year Family $30/2years Family $40/3 years
Each additional family member: $5.00/year
Juniors (under 18) $5.00/year – non voting membership
Enclose check or money order payable in US dollars to: MAMASC (A $25.00 fee will be charged for returned checks). Please mail this completed form and dues to:
Melinda Stevenson, Treasurer- MAMASC, 27560 East 77th Street, Broken Arrow, OK 74014
PAYPAL address is mamasc@ Please add 3% to your dues amount.
Board Approved: 2/08 9/12
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