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
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)
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: