Name (print clearly or type) ____________________________________________________

Address: ______________________________ City: ______________

State / Province: _______________ Zip / Postal Code: ______________ Country: _______________

Phone: _______________________ EMAIL: _______________________________________

Check all below which apply to you:

____ North American Partner New Membership (USA and Canada) $40 (*3 years for the price of 2 years $80)

____ North American Partner Renewal Membership (USA and Canada) $40 (*3 years for the price of 2 years $80)

____ International Partner Membership (as I reside outside the USA and Canada) $20 (*3 years for the price of 2 years $40)

____ I am eligible to be an IAADP Partner (voting member) as my dog meets the IAADP Minimum Training Standards
        (see Partner Membership Definition section above).

____ I am an IAADP Friend (non-voting member) $40

____ I am a Provider Member (train assistance dogs for others) $50

____ I'm partnered with a: (Please Circle One)    Guide Dog      Hearing Dog       Service Dog

____ My assistance dog is trained by me to the required IAADP Minimum Training Standards

____ My Provider trained assistance dog is from: _____________________________ (Provider's Name)

Dog's name: ___________________ Breed / Mix _____________ Date of Dog's Birth ___________  
 

Partner Member Affadavit: (note: your signature is required for enrollment or renewal)  
By signing this document, I affirm the information provided on this application is correct and truthful.

Signature: ________________________________________ Date: ______________________

Choose Newsletter Format: (Please Circle One)     Print       Cassette       Disk       Data CD

Submit application with a check or money order made payable to IAADP. Applicants outside the U.S. must send U.S. currency or an international check / money order. Applications may also be submitted online and alternative methods of payment are available on the IAADP website using PayPal. 

Please Note: From the time of receipt of payment, a period of 45 to 60 days will be needed to process the application. Membership begins immediately upon the receipt of your Membership Card and Packet. Please be patient as we rely on volunteers to carry out most of the work done by IAADP for its members.

Mail to: IAADP c/o Dana Spears * PO Box 638 * Sterling Hts, MI 48311