Date  

      *First Name                                                   *Last Name
       
       Address
    
       City                                                      State                          Zip
    

      Country                             Region#   Color Patterns                       Phone
           
       Fax                                                     *eMail Address
              
       Cattery
    
      Web Address
    

                                                                           

DUES
Quantity	Item	Price
	$25 - Regular US or Canadian Membership - 1 vote per membership
	$25 - Regular US or Canadian Membership - Each additional member
	$35 - Regular Foreign Membership - 1 vote per membership
	$35 - Regular Foreign Membership - Each additional member

Topic

Do you wish to be linked on the Member Page? $10 email link    $10 website link     $15 - Both   NO

NOTE: To pay with a credit card click HERE

Are you a ASH Breed Council Member?   Yes / No

Do you want to participate in the club?      Yes / No

    If yes, in what manner? Website updates? Newsletter, other explain......

Club Use Only

# votes____ Amount Received $ __________ Method Paid __________ Date Received _______