THE DOBERMANN CLUB OF WESTERN AUSTRALIA (INC.)

P.O. BOX 215, Wembley WA 6913.

APPLICATION FOR MEMBERSHIP/RENEWAL OF MEMBERSHIP

PLEASE PRINT IN BLOCK LETTERS

I/We Mr/Mrs/Ms

do hereby apply/renew for ordinary/associate membership of the Dobermann Club of Western Australia (Inc.). I fully support the objectives of the Club and agree to be bound by the Constitution, Domestic Rules of the Club and Code of Ethics, as is or may be amended from time to time according to the Constitution.

It is a condition of membership of the Dobermann Club of Western Australia (Inc.) that:

All puppies born under the Prefix held by a member shall be tattooed with a number issued by the Dobermann Club of Western Australia (Inc.).

All dogs owned by a member are to be identifiable either by tattoo or microchip.

SIGNATURE OF APPLICANT(S): WITNESSED BY:

APPLICANT(S) ADDRESS:

POSTCODE: _________ PHONE NUMBER: MOBILE:

EMAIL:

FEES: $_____________ BEING FOR

(type of membership)

WHERE DID YOU HEAR ABOUT THE DOBERMANN CLUB OF WA ? (Tick One)

YELLOW PAGES £ WEST AUSTRALIAN £ SUNDAY TIMES £

BREEDER £ CANINE ASSOCIATION £ VET £

OTHER (Please Specify)

PET NAME OF DOG/BITCH(S):

PEDIGREE NAME OF DOG/BITCH:

REGISTRATION NUMBER(S):

TATTOO NUMBER(S):

DATE BORN:

COLOUR:

SIRE: __ DAM:

	ORDINARY * Membership		ASSOCIATE Membership
	New Member	Renewals	New Member	Renewals
Single
Standard	40.00	30.00	30.00	20.00
Pensioner or Country	25.00	15.00	20.00	10.00
Joint
Standard	47.00	35.00	42.00	30.00
Pensioner** or Country	32.00	20.00	27.00	15.00

* See Section 8 of Domestic Rules for definition

** Both Applicants must be recipients of a Health Care Concession Card as issued by the Commonwealth Government.

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OFFICIAL USE ONLY:

Fees of $ _____________________ Receipt No.

Date: ________________________ Treasurer’s Signature:

Date presented to Management Committee: ____________________________ Date Approved: _______________________________________