Brunswick Valley Kennel Club
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Mt Warning

space Updated 09-Jul-2017

Print, complete, and post

New member/Renewal [Please circle one.]

Mr/Ms/Mrs


Given name:


Surname:


Address:


State:


Phone:


Email:

Annual fee (2017-18): ordinary membership (single/dual) $10.00; junior membership (12-17 years of age) $1.00.
The fee is GST-free: the club is not registered under the Australian government's GST system.
Membership is for one financial year. Renewals are due by June 30 each year.

Please register me/us as an ordinary member or a junior member. [Circle applicable category.]

I/we enclose $10.00 for the ordinary membership fee, or $1.00 for the junior membership fee.
To pay —

  • Deposit or make an electronic funds transfer direct to the club with these account details: {account name} Brunswick Valley Kennel Club Inc {financial institution} BCU Credit Union {bsb} 533-000 {bank account number} 222908 — Put your name as a reference (e.g. SurnameName) to the transaction. Please email the club treasurer after you have made the transaction.
  • Or, make a cheque or money order to 'Brunswick Valley Kennel Club Inc', and post it to the address below.

I/we agree to abide by the rules and regulations of Dogs NSW.

I/we am a financial member of Dogs NSW or another ANKC-affiliated body. Yes/No [Please circle.]
Membership number:

I acknowledge that membership entitles me to receive a copy of the bi-annual club diary sheet with information on shows in the forthcoming year in northern New South Wales. Please email the diary sheet to me to the above email address (instead of posting a copy). Yes/No [Please circle one.]

Signature:
Date:

Post to:
The Secretary,
Brunswick Valley Kennel Club
12 Possumwood Close
Tyalgum NSW 2484