MEMBERSHIP / RENEWAL FORM

Name Details:: First Name:
Last Name:
Name Details 2:: Complete second Name line for Double OR Junior Membership - MUST BE AT SAME ADDRESS
First Name:
Last Name:
Address Details:: Line 1:
Line 2:
City:
Country:
Australia
State:
Postal Code:
Telephone/Mobile Number:
Email Address:
: MEMBERSHIP TYPE
Membership applying for:
Please attach concession card
Please attach concession cards
(Copy): Dog details
Dogs name:
Birth year:
Breed:
: Further Dog Information
Type:: DogBitch
Desexed:
Microchipped:
Vaccinated:
Upload Vaccination Certificate
: Additional dogs
More than 1 dog?:
(Copy) (Copy): 2nd - Dog
2nd - Dogs name:
2nd - Birth year:
2nd - Breed:
(Copy): 2nd - Further Dog Information
2nd - Type:: DogBitch
2nd - Desexed:
2nd - Microchipped:
2nd - Vaccinated:
2nd - Upload Vaccination Certificate
(Copy) (Copy) (Copy): 3rd - Dog
3rd - Dogs name:
3rd - Birth year:
3rd - Breed:
(Copy) (Copy): 3rd - Further Dog Information
3rd - Type:: DogBitch
3rd - Desexed:
3rd - Microchipped:
3rd - Vaccinated:
3rd - Upload Vaccination Certificate
: I agree to abide by the Constitution/Rules of the Dover Gardens Kennel & Obedience Club Inc
Person 1:
Date signed:
: second signature for Double Membership OR Guardian for Junior Member from 13 years
Person 2:
Date signed:
How did you hear about Dover Dog Club?:
Please subscribe me to the Club Newsletter: