The Chihuahua Club of NSW

The Chihuahua Club of NSW

Application for Membership
Name *

Prefix First Name Last Name
Postal Address *

Street Address

Street Address Line 2

City State

Post Code
Phone Number

Area Code Phone Number
Mobile Number

04nn Mobile Number
Email
example@example.com
I am a

Registered Breeder Exhibitor Pet owner
Prefix
Dogs NSW Membership number
Date of birth if under 16

Day Month Year
Date
Type of Membership *

Single ($15) Dual ($20) Junior u-16 ($5) New Puppy ($5)
N.B. Between 1st January and 30th June the fees shall be half the yearly rate, when applying for the first year only
If Dual Membership, Name of other member

First Name Last Name
Payment method *

Bank transfer Cheque by mail
Preferably, do a direct transfer in to our account with your name as a reference

BSB 032 260

A/c 240269

Alternatively, mail cheques (made out to The Chihuahua Club of NSW) to:

11 Qualitary Road, Merungle Hill, Leeton, NSW, 2705.
Should be Empty: