New Membership Form

WHITE SWISS SHEPHERD DOG CLUB OF AUSTRALIA INC. A0043538A

NEW MEMBERSHIP FORM
Type of Membership*

Family/Dual - $35.00Single - $25.00Concession* - $20.00
*Concession Card Number (if applicable)
Member Name 1*

PrefixFirst NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Member Name 2

PrefixFirst NameLast Name
Phone Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail
Member Name 3

PrefixFirst NameLast Name
Member Name 4

PrefixFirst NameLast Name
Postal Address*

Street Address

Street Address Line 2

SuburbState

PostcodeCountry
Canine Association Membership Number
My interest is*

ShowingBreedingPetObedience/AgilityOther
Nominator Details*

Full NameKennel 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*
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WHITE SWISS SHEPHERD DOG CLUB OF AUSTRALIA INC. A0043538A