APPLICATION FOR MEMBERSHIP/ASSOCIATE MEMBERSHIP
Circle type of application

Please print this form, complete and forward to:
The Secretary
PO Box 4017
LONDONDERRY NSW 2753
Please include a stamped self-addressed envelope
 

Name:______________________________________________________________________  
                     Mr/Mrs/Ms                                          First  Name                                                             Surname

Address: ____________________________________________________________________
                           No                                              Street / Road

____________________________________________________________________________ 
                       Suburb                                            State                                                                      Postcode

Phone:_________________(day) ___________________(ah) ___________________(Mobile)

Email address: _______________________________________________________________

Dog Purchased From (Name/Prefix): ______________________________________________

Your Breeders Prefix (if applicable): _______________________________________________

RNSWCC Membership No: (or equivalent) ________________________________________

I have read and understand the Code of Ethics and agree to abide by these and any others that the RNSWCC apply.

Signed: _____________________________________________________________________

                        Must be proposed and seconded by existing member except for Subscription

Proposed by: ________________________ Seconded by: _____________________________