TRACKING AND RESCUE DOG CLUB OF NSW INC

APPLICATION FOR MEMBERSHIP/MEMBERSHIP RENEWAL

MR/MRS/MS      _____________________              ____________________________
                           SURNAME/S (PLEASE PRINT)           FIRST NAME/S

ADDRESS          ___________________________________________________________

                       _____________________________________ POST CODE ___________

 PHONE:  HOME (    )___________________              WORK (      ) ________________

RNSWCC MEMBERSHIP NO:  _______________________

DOG NAME BREED

I/We hereby agree to observe and perform and in all respects to conform to and be bound by the Constitution and Regulations of the Club.

I/We indemnify the Club against any claim for damages for personal injury however caused.

SIGNATURE (S)               __________________________________________________ 

                                         ___________________________________________________

FEES:         SINGLE MEMBERSHIP $15.00              DUAL MEMBERSHIP $20.00

POST TO:       The Secretary

Tracking & Rescue Dog Club of NSW Inc

82 Marine Parade

Maroubra NSW 2827

OFFICIAL USE ONLY   DATE RECEIVED                             /   /         AMOUNT: $                                       RECEIPT

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