NORTHERN COUNTIES CHIHUAHUA CLUB

MEMBERSHIP APPLICATION FORM




I/We would like to become a member of NCCC and request that my/our application be submitted to the committee.  IWe agree to abide by the rules and regulations of the Club and understand that I/we will not be entitled to any privileges of membership until after election and/or whilst any subscriptions is unpaid.  In completing this application I/we accept that the information given on this form will be stored in the NCCC database, for their records, instrict accordance with the Data Protection Act.  Please complete and return to the Secretary by hand or post with your remittance to the above address.

PLEASE PRINT :

NAME....................................................................................
ADDRESS.................................................................................
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TELEPHONE NUMBER..........................................................
AFFIX.................................................................................

E-MAIL ADDRESS Please print

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BREED(s) OWNED..............................................................
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SIGNATURE.........................................................................
DATE..................................................................................

Membership: Single - £3.00     Joint - £4.00
Please delete the one NOT required.
Membership runs from January to December.

(can be paid by Standing Order.)