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SoEBHC Membership Application

Last Updated on Tuesday, 20 January 2009 12:50 Written by Administrator Friday, 16 January 2009 23:55

Print

Please complete (CAPITALS ONLY), print & send this form - One form per Adult or per (2) Joint Adults or per Junior please, send with total remittance to the Secretary.

 

Personal Information Red Star * fields are required

About YOU & Your Partner
(continue on separate sheet if needed)
First Name *
Last Name *
Partners First Name *
Partners Last Name *
Address 1 *
Address 2
Address 3
Town/City *
County *
Postal Code *
Evening Phone *
Mobile
Fax
Email
Please give brief details of your association with Basset Hounds (on a separate sheet if needed)
Membership: Please indicate the membership class you require & ensure you provide a cheque or postal order for the total value. If you would like to, please include an amount
to be treated as a donation.
Adult £5.00: a single adult (aged 17+)
Joint £7.00: 2 adults residing at the same address or joint owners
Junior £1.00: up to and including 16 years of age
Donation
Total Remittance:
Cheque/P.O. Number
Your Signature
Partners Signature
Date
Please Note: Upon joining the South of England Basset Hound Club you consent to the club sending your name & address details to the Kennel Club. Your details, both at the SOEBHC & the Kennel Club will be stored on separate computer systems. Furthermore, you agree to abide by all parts of the clubs Constitution & Rules and Code of Ethics.
Countersigned: (To be completed by a fully paid up member of the Club)
I (name) support this application for
membership of South of England Basset Hound Club
Signature
Date