NSDTR Club NZ Membership Application

Nova Scotia Duck Tolling Retriever Club of NZ Membership Application

Please complete all sections and submit.
Type of Membership*

IndividualFamilyJuniorOverseas
Membership fees for both NZ and Overseas members are (in NZ dollars): Individual $20; Family $25; Junior $15.
How many persons in Family Membership*
Date of Birth*

DayMonthYear
Name*

First NameLast Name
Person 2 Name*

Person 2 First NamePerson 2 Last Name
Person 3 Name*

Person 3 First NamePerson 3 Last Name
Person 4 Name*

Person 4 First NamePerson 4 Last Name
Postal Address*

Street Address or PO Box Number

Suburb

City or TownState / Province

Post/Zip CodeCountry
Phone Number*

Area CodePhone Number
Email address*

Confirmation EmailConfirm email address
Do you own or part-own a Toller?*

YesNo
How many Tollers?*
Dog's Name*
Call Name*
Dog's Titles or Awards (if any)

Prefix(es)Suffix(es)
Dog 2 Name*
Dog 2 Call Name*
Dog 2 Titles or Awards (if any)

Prefix(es)Suffix(es)
Dog 3 Name*
Dog 3 Call Name*
Dog 3 Titles or Awards (if any)

Prefix(es)Suffix(es)
I agree to receiving newsletters and notices from the Club via email.*

YesNo
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