NESDCA Membership Application

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 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/Province
Country
Zip/Postal Code
Telephone
Fax
Email Address

FEE: Regular is $225.00 annually for 1st membership, $100.00 each additional member. Sponsor is $100.00 annually for individual, $1000.00 for company advertising.. Please indicate type membership.below.
	Regular Member Sponsor

1. QUALIFICATIONS OF APPLICANT a. If applying as a Regular Member, which only applies to canine teams who will obtain certification. List each handlers name along with the name of the canine they will be certifying with to the right of the handlers name.

b. If applying as a Sponsor, which applies to any one who supports Entomology Scent Detection. Please provide information regarding your background and/or interest in Entomology Scent Detection.

c. Provide the name and location of the training facility from which you and your canine were trained.

d. Are you willing to abide by, support, and promote NESDCA, our by-laws and mission of Entomology Scent Detection? YES NO

2. REPRESENTATION Indicate below the name of the business you would be representing.


a. Please provide a business address, telephone number, along with a specific contact person and their mailing address, e-mail, and telephone number.


3. 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