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BOXER CLUB OF WESTERN AUSTRALIA

MEMBERSHIP APPLICATION FORM
(please print clearly)

NAME:   ____________________________________________________________________________________

ADDRESS:   _________________________________________________________________________________

Postcode:   _________________ Ph. No.  _____________________ Mob: ___________________

EMAIL ADDRESS: ___________________________________________________

SIGNATURE OF APPLICANT: ___________________________DATE: ________


TYPE OF MEMBERSHIP (please tick)

REGISTERED BOXERS Double $30 (     ) Single $25 (    ) Pensioner $25 (     )
Copy of concession or Pension Form Required

International $30 (     )

(Associate Members reduce by $5)

Registered name of Boxer: ____________________________________________

Reg No.: _____________________________________________________________

ASSOCIATE MEMBERS

Being a person or persons who have a genuine interest in the breed but who do not currently own a registered Boxer, or for those who own WHITE Boxers which have been sterilised and therefore will not be used for stud or breeding purposes (Please provide a copy of sterilisation certificate when returning this application)

CHEQUES PAYABLE TO THE BOXER CLUB OF WESTERN AUSTRALIA

Please post to:
Mrs J Canham
20 Fielder Road   Serpentine WA 6125   (Australia)

Ph:  08 9525 7687

Email:  jcanham@ozemail.com.au

NB: I/We have read the attached Constitution of the Boxer Club of Western Australia and hereby agree to be bound by the rules and regulations contained therein.

SIGNATURE(S):

____________________________________________

____________________________________________