Membership App

DSA Membership Form

Use this form if you will be paying for your membership using PayPal. Once you submit this form, you will be taken to the PayPal page. Make a note of your total before submitting the form. If you have any problems, please contact: DogScoutCamp@gmail.com

Your Name (active membership $25): *
Names of participating Family Members from your household ($5 each):
Total for Membership $: *	$
Street Address: *
City: *
State: *
zip code: *
Phone with area code: *
Primary Email: *
My Yahoo Group user name or Yahoo email address (if you have one):
Dog's Name:
Breed (or best guess):
Dog's Name:
Breed (or best guess):
Dog's Name:
Breed (or best guess):
If you have more than 3 dogs, please list them here, along with their breed/mix:
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 #:	#
I plan to be a member of a future troop in (city):
This is the amount due that I will immediately pay through PayPal after I click submit : *	$
Date Submitted: *