APPLICATION FOR MEMBERSHIP / RENEWAL

Membership Renewal Fees are due to be paid by 1st March each year

Membership Fees
Single Membership: $18.00 per annum
Double Membership: $22.00 per annum

PLEASE NOTE : - Receipts will not be issued unless requested.

NAME/S: ________________________________________________________________________________________

ADDRESS: ______________________________________________________________________________________

_____________________________________________________________________POSTCODE: _______________

TELEPHONE: Home: ___________________________________ Work: _____________________________________

Mobile: _______________________________________________________________

EMAIL : _________________________________________________________________________________________

 PREFIX (If Applicable)______________________________________________________________________________

Dogs SA (or other state) Membership Number (If Applicable): _____________________________________________

I/We wish to apply for membership / renew membership (please delete one option)
of the Cavalier King Charles Spaniel Club of S.A. Inc.
I/We agree to be bound by the Constitution and Rules and the Code of Ethics of the Club.

SIGNED: ________________________________________________________________________________________
(Both parties to sign for Double Membership application)

Please forward this application together with the required payment to:
The Secretary,
Mrs Sally Paterson,
8 Flinders Avenue
Fairview Park SA 5126