| APPLICANT'S NAME:_____________________ DATE__________
BUSINESS/DEPARTMENT NAME__________________________
TITLE ____________________________________________________
MAILING ADDRESS _____________________________________
CITY__________________________ STATE____ ZIP____________
BUSINESS PHONE:____________ HOME PHONE____________
FAX:____________ EMAIL ADDRESS:________________________
CANINE INFORMATION
NAME OF CANINE:_____________________ BREED:____________
SEX:__ AGE:___ IN-SERVICE DATE________________________
TYPE OF ALERT:____________ TYPE OF REWARD:____________
TRAINER:________________________ LOCATION:____________
IF CROSS TRAINED, PLEASE EXPLAIN: __________________
______________________________________________________
CADA would like to publish your member
information in a CADA Member Directory.
May we use your information in the directory? ____yes____no
Would you like an E-mail link on our Web site? ____yes____no
Return application to:
2004 CADA MEMBERSHIP
ATTENTION: BOB GARTNER
9180 MORGAN ROAD
MONTVILLE, OH 44064
|
