Name *

First Name

Last Name

Name of additional household applicant

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

What is your involvement with the Bergamasco breed? *

Owner

Breeder

Handler

Trainer

Admirer

What activities do you enjoy with your Bergamasco?

Conformation

Agility

Barn Hunts

Rally

Herding

Obedience

Therapy

Family Companion

N/A

Other

I am interested in participating in the following NBSA projects

Breed rescue

Club publications

Club fundraising

Website

Health and genetics

Shows and events

Constitution//By laws/ Ethics

Judge education

Other

Membership desired *

Club member Single $20

Club member Family $30

International member/Other

My dog is/are registered with *

UKC

AKC

FCI

Other

N/A

If elected to membership, I will abide by the Constitution, Bylaws, and the Code of Ethics of the National Bergamasco Sheepdog Alliance and the rules and regulations of the United Kennel Club *

Yes

No

Date of application *

MM

DD

YYYY