| Your Name (active membership $25): * |
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| Names of participating Family Members from your household ($5 each): |
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| Total for Membership $: * |
$ |
| Street Address: * |
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| City: * |
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| State: * |
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| zip code: * |
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| Phone with area code: * |
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| Primary Email: * |
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| My Yahoo Group user name or Yahoo email address: * |
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I understand that once my membership is processed, I need to apply to join the Newsletter Yahoo Group so I will get the passwords for the DSA newsletter each month: *
(a reminder will be sent to you) |
(yes)
(required) |
| Dog's Name: |
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| Breed (or best guess): |
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| Dog's Name: |
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| Breed (or best guess): |
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| Dog's Name: |
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| Breed (or best guess): |
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| Total Amount Due ($5 each) for Cadet Scout tags: (put 0 if no tags purchased) $: * |
$ |
| I am including an additional $25 donation for a CONTRIBUTING MEMBERSHIP to help DSA's Educational Programs $: |
$ |
| I am including an additional $75 donation for a SUSTAINING MEMBERSHIP to help support DSA's educational Programs $: |
$ |
| I am a member of a troop: |
(yes/no) |
| If yes, please include the troop number #: |
# |
| This is the amount I will immediately pay through PayPal after I click submit $: * |
$ |
| Date Submitted: * |
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