NESDCA uses the information in this application to determine your qualifications for membership and to ensure that NESDCA will contain a fair balance of interests. NESDCA will not use this information for any other purpose than the above. Please provide us with as much information as you feel will assist us in the APPROVAL process.

Use this form only if you want to apply and pay for your membership online. Payments are accepted through PayPal.

If you prefer to mail in your payment please download and fill out the membership application here.


Name of Individual
Title
Employer
Mailing Address

City
State
Zip Code
Telephone
Fax
Email Address

FEE: $120 annually for 1st membership $50.00 each additional member from same funding source. Please indicate type(s) membership(s) applying for:
	Regular Member Associate Member Trainer (regular member) Evaluator (regular member) Handler (regular member) If applying as a handler please indicate the following: <--- Dog's Name <--- Website Other (Please indicate below)

1. QUALIFICATIONS OF APPLICANT a. Provide evidence of your general knowledge, competence and experience in the scope (work) of NESDCA as it pertains to the membership you are applying for.

b. What is your specific reason(s) for wanting to be a member of NESDCA?

c. Will you be able to actively participate in the work of NESDCA including responding to correspondence and attending NESDCA meetings? YES NO

2. REPRESENTATION Indicate below the name of the entity you would be representing and include written authorization from that entity authorizing you to be their representative:


3. Funding Source(s) for your Participation a. What person(s) or organization(s) would fund your participation as a member, either in whole or in part? (You should list your employer if your participation is funded by your employer or if your participation is part of your employment responsibilities or otherwise related to your employment.)

b. Background and description of your employer and/or other person(s) or organization(s) funding participation:


4.ADDITIONAL COMMENTS


I agree to abide by the RULES and BY-LAWS NESDCA and agree to notify the Secretary of the NESDCA of a change in status, including change of employment, organization represented, location or funding source. I attest that all of the information on this application is true and accurate.
Type your FULL NAME
Today's Date

© 2007 NESDCA |ALL NESDCA LOGOS, NATIONAL ENTOMOLOGY SCENT DETECTION CANINE ASSOCIATION, ENTOMOLOGY SCENT, and ENTOMOLOGY SCENT DETECTION are TRADEMARKS of NESDCA and MAY NOT be USED without the Written Consent of NESDCA