Space Coast War Dog Association

PO Box 254315 Patrick AFB, FL 32925

 

Membership Application

 

First Name: ______________________________________ Last Name: ____________________________________________

Address: _______________________________________________________________________________________________

City: _________________________________________ State: ______________ Zip: _______________

Home Phone # (_____)______________________ Email Address: ______________________________

Home Page http:// _______________________________

K-9 Unit/Branch/K-9 Name Brand Number ____________________________________________________________________

I as listed above, will not discriminate SCWDA members or SCWDA supporters based on race, color, religion, sex, handicap, national origin, age or ethnic group; nor will I participate in any organization or activity which engages in discriminatory practices.

I am aware my membership will automatically terminate on the occurrence of any of the following causes:

-Voluntary resignation

-Expiration of membership (failure to pay yearly dues)

-Destruction of SCWDA property including electronic media and data files

-Misrepresentation of the SCWDA

-Falsifying information on application for membership

-Causing false information to reach the public/media in any form

-Misrepresenting oneself to the public for the purpose of soliciting charity

-Or if SCWDA Officers find me discriminating a member or SCWDA supporter based on race, color, religion, sex, handicap, national origin, age or ethnic group.

I understand the Termination of Membership: YES or NO (circle one)

I DO / DO NOT (circle one) want my information above added to the SCWDA web site.

Note: At any time you can email the SCWDA and change your status. For an example see the members page on the SCWDA website.

Annual membership fee is $20.00. Please enclose check or money order with this application made out to the "Space Coast War Dog Association."

 

Signature: _____________________________________ Date: _________________________

When Membership dues are received you will be mailed a Membership letter and Membership Card. Each card will be assigned a membership number. Membership numbers can not be reserved or specifically requested.