Name (Last, First, Middle Initial) *

Street Address*

City*

State & Zip*

Home Phone *

Cell Phone *

Email Address *

Occupation

Emergency Contact: Name/Relationship/Cell Phone *

How were you introduced to Mid-Atlantic Stewards Association?

Breeds you own:

Do you show? Do you show? Yes No

NOHS? NOHS? Yes No

Dog Organizations you belong to:

Your participation in these organizations (i. e., Officer, Committees, etc.):

Do you have any experience stewarding conformation rings? Do you have any experience stewarding conformation rings? Yes No

If yes, please provide a brief summary:

Have you completed the AKC “Stewarding 101” course? Have you completed the AKC “Stewarding 101” course? Yes No

If yes, please provide date:

Have you completed the AKC “Stewards of Children” training? Have you completed the AKC “Stewards of Children” training? Yes No

Are you an AKC Certified Steward? Are you an AKC Certified Steward? Yes No

Do you have any experience in stewarding performance events? Do you have any experience in stewarding performance events? Yes No

Please give a brief explanation of your reason(s) for applying for membership in MASA:

Have you, or anyone in your household ever been suspended or denied membership by AKC or other dog-related organization? Have you, or anyone in your household ever been suspended or denied membership by AKC or other dog-related organization? Yes No

If yes, explain:

* Please check the box below to agree to the following statement: * Please check the box below to agree to the following statement: You will need to serve three under-instruction assignments with experienced stewards. Depending upon your experience, you may serve more or less assignments as deemed by the Board. While serving your provisional assignments, you may not exhibit dogs on that day but may use a handler. If I have not completed my training within one year I will be required to reapply. If approved for membership, I agree to adhere to the Constitution and Bylaws of American Kennel Club and MASA.

Signature *

Date *

Are you applying in order to fulfill the AKC requirement to become a Judge? (There is a $35.00 training fee. AKC requirement - act as an assigned steward at six AKC approved all-breed shows with 75+ entries.) Are you applying in order to fulfill the AKC requirement to become a Judge? (There is a $35.00 training fee. AKC requirement - act as an assigned steward at six AKC approved all-breed shows with 75+ entries.) Yes No

Are you applying as a Junior member? Are you applying as a Junior member? Yes No

If Applying As A Junior Member, Please Provide Date Of Birth: mm/dd/yy

Parent Signature

Date