Fila Brasileiro Association, Inc. Karl Henley, Treasurer 4607 Oak Creek Drive Arlington, TX 76017-1661 E-Mail: Cherokeedeb@msn.com

FBA MEMBERSHIP APPLICATION
Please print

Name:_____________________________________________________________________

Address:___________________________________________________________________

City:______________________________  State:__________________  Zip:____________

Phone: (____) - _____ - ___________   E-MAIL:___________________________________

I presently own ____ Fila/s.

Indicate number of   _____ Show Quality   _____ Breeding Quality   _____ Pet Quality

____ Dog/s (M)   ____  Bitch/s (F)        Colors: ____ Fawn   ____ Brindle   _____ Black

Kennel Name (if appropriate) ___________________________________________________

Please attach a copy of FCI registration (pedigree optional) and HD Certificate if available.

I hereby apply to the Fila Brasileiro Association, Inc. (FBA) for membership. I agree to abide by
its rules and bylaws. In addition, I will follow only the original standard of the breed as
recognized by the FEDERATION CYNOLOGIQUE INTERNATIONALE (FCI).

Signed:_______________________________________________ Date: ___/___/________
Individual

Signed:_______________________________ Signed:______________________________
Family

Please mail this application along with your check (made payable to the FBA) to the Treasurer.

May copies of your records be shared with other members of the FBA? ____ yes   ____ no

I would like to be a FBA delegate for the state/country of: ___________________________