RYLSTONE KANDOS & DISTRICT DOG CLUB
APPLICATION FOR MEMBERSHIP
Year Ended
Please print all details in block letters:
SURNAME: ………………………………………............................
OTHER NAMES: ……………………………….................................
SURNAME: ………………………………………............................
OTHER NAMES: ………………………………................................
ADDRESS: …………………………………………………………..
POST CODE: ………………..
PH NO.:………………..............
DOGS NSW NO: ……………………………
BREEDERS PREFIX & BREEDS OF DOGS OWNED: ……………………………………………….
D.O.B. (JUNIOR ONLY…/…../……EMAIL
ADDRESS……………………………………………….
I/we hereby certify that the information given is true and correct to the best of my/our belief & I/we hereby apply for membership to the Rylstone-Kandos Dog Club in accordance with the rules and regulations of the said Club and of Dogs NSW and I/we agree to comply with all such rules and regulations.
Please note: All members named on this application must sign below to acknowledge agreement to comply with the above conditions of membership
APPLICANT(S) SIGN HERE: ……………………………………………………..
DATE: ………………
APPLICANT(S) SIGN HERE: ……………………………………………………..
DATE: ………………
PROPOSER SIGN HERE (new memberships only) …………………………………………………….
SECONDER SIGN HERE (new memberships only) …………………………………………………….
MEMBERSHIP FEES –
| | SINGLE $10.00 | | FAMILY/DUAL $10.00 | | JUNIORS/PENSIONERS $2.00 |
APPLICATIONS SHOULD BE FORWARDED TO:
THE SECRETARY DON MAHONEY 673 KAINS FLAT ROAD, MUDGEE NSW 2850
OR
THE TREASURER, NANCY KECK
(Remittances in favour of Rylstone-Kandos & District Dog Club)