The Chihuahua Club of NSW Inc.

The Chihuahua Club of NSW Inc.

Application for Membership
Name

PrefixFirst NameLast Name
Postal Address

Street Address

Street Address Line 2

CityState

Post Code
Phone Number

Area CodePhone Number
Mobile Number

04nnMobile Number
Email
example@example.com
I am a
Prefix (Required for Breeders)
Dogs NSW (or relevant State) Membership number. Required for Breeders
Date of birth if under 16

DayMonthYear
Date
Type of Membership
N.B. Between 1st January and 30th June the fees shall be half the yearly rate, when applying for the first year only OR If full fee paid, it covers you for the next financial year as well.
If Dual Membership, Name of other member

First NameLast Name
Payment method
Please do a direct transfer in to our account with your name as a reference to:-

BSB 032 260

A/c 240269
Please mail cheques (made out to The Chihuahua Club of NSW) to:

11 Qualitary Road, Merungle Hill, Leeton, NSW, 2705.
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