Transcript Slide 1
MEMBERSHIP APPLICATION & RENEWAL FORM 2014
I/We wish to become Members of the Northern Counties Shih Tzu Club.
Name: Title………...... First Name(s)…………………………......Surname…......................................……………….............
Address: …………………………………………………………………………………..................................................................
Post Code: ………....................... Telephone No.: ………………………………………………………………………………….
Kennel Affix: ……………………………………………………………………………………………………………………………..
Email : ……………………………………………………….. …………………………………………………………………………..
New Members Only
Proposer Name :…………………………………………………………............................................................(block capitals) Proposer Signature :…………………………………………………………………………………………………………………….
Seconder Name :……………………………………………………………………………………………...……...(block capitals) Seconder Signature :…………………………………………………….....................................................................................
(Both Proposer and Seconder must be current Northern Counties Members) Please take time to complete the following short questionnaire: Are you are per owner Breeder Exhibitor (please tick all that apply) How many Shih Tzu do you own? Dogs Bitches.
What other Breed Clubs do you belong to:…………………………………………………………….................................…...
Do you own or breed any other KC breeds (if yes which ?) …………………………………………………………………….
Are you on any Judging List ? (If yes please list)…………………………………………………………………………………
Membership Required Single Joint Membership Junior Membership Overseas Membership Price £5.00
£7.00
£3.00
£7.00
Quantity Total Payable £ £ £ £ £ Total I/we enclose a cheque for £___________ payable to
NORTHERN COUNTIES SHIH CLUB (N.C.S.T.C.)
.
If accepted as a Member, I/we accept to be bound by the Northern Counties Club Rules ad Regulations and also its Code of Ethics, copies of which I/we have read and understood.
Signed
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Signed
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Date
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