MEMBERSHIP APPLICATION
Please print out the application, complete and send to:
The Secretary, PO Box 38851, Winnellie
NT 0821
Please note that your contact details are for the
use of the Club Secretary and if you do NOT wish them to be passed on to
people interested in your breed then please check the appropriate box
FEES: Double $12.00 Single $10.00 Junior
$5.00
Financial Year 1 January to 31 December
| Name |
|
| Postal Address |
|
| Residential |
|
| Home Phone | |
Work Phone |
|
| Mobile | |
E.mail |
|
| Webpage | |
| Breed(s) owned |
|
| |
|
|
I do NOT wish my personal details to be made available to people enquiring about my breed |
| Comments eg: webaddress or |
|
| e.mail only OK |
|
| Signature |
|
| Date |
|