Please print out the following membership form and send to

together with your fees.  Please make all cheques and postal orders
payable to the Keeshond Club of SA Inc.

 

THE KEESHOND CLUB OF SOUTH AUSTRALIA INC.
Affiliated with the South Australian Canine Association Inc.

APPLICATION FOR MEMBERSHIP / RENEWAL
(delete as required)

FINANCIAL YEAR 1ST JANUARY -   31ST DECEMBER

 

NAME:_____________________________________________________________________________

ADDRESS:_________________________________________________________________________

PHONE:_____________________________STATE_______________POST CODE_______________

KENNEL NAME_______________________________REG. NO.______________________________

 

MEMBERSHIP TYPES                                                          SINGLE             DOUBLE                 
Normal                                                                                $10.00               $15.00
Concession                                                                          $ 5.00               $ 8.00
Junior                                                                                  $ 3.00                    -
Breeders Directory ($5.00 per annum)                                   YES                     NO
TOTAL:                                                                                $____________________

Signature(s):________________________________________

Concession Card No.:_______________________________Expiry Date______________________

 

All memberships include a newsletter, published quarterly.

* Double Membership includes 2 Children under the age of 17 years.
* Junior Membership ID for Children under 17 years of age.
* Concession includes Pensioners, Students over the age of 17 years and the Unemployed.    Concession card numbers required.

PLEASE CIRCLE CATEGORIES:               PET          OBEDIENCE        CONFORMATION

HOW MANY KEESHONDS DO YOU OWN? ___________

CLUB BADGES, KEYRINGS & MUGS ALSO AVAILABLE AT $5.00 EACH