THE LOWCHEN CLUB OF N.S.W.
Membership Application/Renewal
From 1st July 2010
Name(s)…………………………………………………………………………………
…………………………………………………………Age (if under 16)……………..
Address…………………………………………………………………………………
…………………………………………………………Post Code…………………….
Country……………………………Kennel Prefix……………………………….…..
Phone……………………Mobile………………..Email………………………………
MEMBERSHIP TYPE
Dual $15 [ ] Single $10 [ ] Junior $7.50 [ ]
Pensioner
Single $7.50 [ ] Dual $10 [ ]
Do you own a Lowchen? [YES] [NO] Are you a member of Dogs NSW?
[YES] [NO]
The Club Secretary receives puppy enquiries from other Members or Members of the Public. Do you give permission for the Secretary to divulge your contact details in relation to such enquiries? [YES] [NO].
How do you wish to receive your newsletter? By Email [ ] Hardcopy by Post [ ]
(Please tick one)
Applicants Signature(s)……………………………………………………………….
Nominated……………………………Seconded……………………………………
(Nominations only required for New Members)
Please Note: If applicant is under 16 years of age, parental consent and signature is required.
