New Membership Form

WHITE SWISS SHEPHERD DOG CLUB OF AUSTRALIA INC. A0043538A

NEW MEMBERSHIP FORM
Type of Membership *

Family/Dual - $20.00 Single - $10.00 Concession* - $5.00
*Concession Card Number (if applicable)
Member Name 1 *

Prefix First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Mobile Number *

Area Code Phone Number
Member Name 2

Prefix First Name Last Name
Phone Number

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail
Member Name 3

Prefix First Name Last Name
Member Name 4

Prefix First Name Last Name
Postal Address *

Street Address

Street Address Line 2

Suburb State

Postcode Country
Canine Association Membership Number
My interest is *

Showing Breeding Pet Obedience/Agility
Nominator Details *

Full Name Kennel Name
Nominator E-mail *
ELECTRONIC FUNDS TRANSFER DETAILS

Bank: Commonwealth Bank Account Name: White Swiss Shepherd Dog Club
BSB: 063 301 Account Number: 10055290

Please ensure you include at least your surname with the EFT Payment so we can reconcile who it is from

CHEQUE or MONEY ORDER

Payable to the 'WSSDCA INC'
By submitting this form:

I/We wish to accept membership of the White Swiss Shepherd Dog Club of Australia Inc.

I/We agree to abide by the Club's Rules and ByLaws (Available on the Club Website)

I/We hereby give permission for the photos of our dogs taken at WSSDCA events or supplied by myself, to be used by the WSSDCA and its associated bodies for the purpose of promotion and advancement of the Club and dogs, in a manner of the Club's choosing for an unspecified period of time.
Signature *

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Please verify that you are human *
Should be Empty:

WHITE SWISS SHEPHERD DOG CLUB OF AUSTRALIA INC. A0043538A