ACODC Online Membership Form

ALTONA CIVIC OBEDIENCE DOG CLUB INC. Membership Form

Financial Year 1st November to 31st October
Application for New MembershipApplication for Membership Renewal
New Membership Fees
- $100.00 - Single Membership
- $190.00 - Dual Membership (2 adults at the same address)
- $ 75.00 - Junior Membership (12 - 16 yrs of age)
- $ 70.00 - Aged Pension Membership
New Membership Pro Rata Fees - August
- $ 75.00 - Single Membership
- $148.00 - Dual Membership (2 adults at the same address)
- $ 69.00 - Junior Membership (12 - 16 yrs of age)
- $ 68.00 - Aged Pension Membership
New Membership Pro Rata Fees - September
- $ 68.00 - Single Membership
- $133.00 - Dual Membership (2 adults at the same address)
- $ 63.00 - Junior Membership (12 - 16 yrs of age)
- $ 62.00 - Aged Pension Membership
New Membership Pro Rata Fees - October
- $ 60.00 - Single Membership
- $118.00 - Dual Membership (2 adults at the same address)
- $ 57.00 - Junior Membership (12 - 16 yrs of age)
- $ 56.00 - Aged Pension Membership
Membership Renewal Fees (November ONLY)
- $ 50.00 - Single Membership
- $ 90.00 - Dual Membership (2 adults at the same address)
- $ 25.00 - Junior Membership (12 - 16 yrs of age)
- $ 20.00 - Aged Pension Membership
Please note: Memberships can only be renewed during the month of November otherwise 'New Membership' fees will apply.
Single MembershipDual MembershipAged Pension MembershipJunior Membership
Age of Junior:
Please note: A Parent or Guardian must remain present for the duration of the training session.
MEMBER DETAILS
Please choose one of the following options:*
Name*

FIRST NAMESURNAME
ADDRESS*
SUBURB*
POST CODE*
MOBILE PHONE*
Email Address
example@example.com
DOG'S NAME*
DOG'S BREED*
DOGS'S DATE OF BIRTH*

DayMonthYear
Date
DOG'S SEX - Male or Female*
- Please choose one of the following options:
- Name
  
  NAMESURNAME
- MOBILE PHONE*
- EMAIL ADDRESS
  example@example.com
- DOG’S NAME (2nd Member)
  If training the same dog as the 1st member just put "As Above"
- DOG’S BREED (2nd Member)
- DOG'S DATE OF BIRTH (2nd Member)
  
  DayMonthYear
  Date
- DOG'S SEX - Male or Female
- NoYes
- To identify who will be training the additional dog, please add two stars (**) after the persons first name in the Member detail fields above.
- DOG’S NAME
- DOG’S BREED
- DOG'S DATE OF BIRTH
  
  DayMonthYear
  Date
- DOG'S SEX - Male or Female
- Dog/s Vaccination Certificates
  
  Please choose an option below to advise how you will send proof of Vaccination
- Upload certificate with this formEmail certificate to info@altonadogobedience.org.auText photo to 0432 745 303
- Certificates can be uploaded here.
  
  Cancelof
- General
  
  Please answer the following three questions.
- NoYes
- NoYes
- NoYes
- If you have answered 'Yes' to Questions 1, 2 or 3, your Membership application will need to be discussed with the Club Secretary prior to joining.
  
  The Club has the right to suspend or disqualify any Member's dog that shows a tendency to bite of show aggression.
  
  JUNIOR Members: Proof of the Junior's age is required and a Parent/Guardian must remain at the Club whilst the Junior Member is in Class. No Members under the age of 18 years are to be left at the Club unsupervised.
  
  I understand that the ACODC Inc does not accept uny responsibility for any injury that may be sustained by me, my family or my dog/s while on the Club grounds.
  
  I agree to abide by the rules and regulations of this Obedience and Agility Dog Club.
- SIGNED:
- Signature (Member)*
  
  Clear
- Signature (2nd Member - if a Dual Membership)
  
  Clear
- DATE*
  
  DayMonthYear
  Date
- FOR JUNIOR MEMBERSHIP:
  
  Parent or Guardian to sign
- Signature (Parent or Guardian)
  
  Clear
- Junior's Parent or Guardians Full Name
  Please type full name
- DATE
  
  DayMonthYear
  Date
- MEMBERSHIP FEES
  
  The Club’s financial year is from 1st November to the 31st October.
  A 'New' Membership Fee consists of a Joining Fee and an Annual Training Fee until Membership Renewal is due during the month of November ONLY.
  Please note: Subject to club rule 8.2, fees are not refundable.
  
  If joining the Club to start training in the months of August, September or October, please view our "Pro Rata" Fees before paying for your New Membership.
  
  PAYMENT
  
  Our preferred payment method is by online EFT (Direct Deposit) transactions.
  
  Our Account details are:
  BSB: 633 000 Account No. 5519764
  Please use your FIRST NAME and SURNAME as the REFERENCE
  
  If you are unable to pay by Direct Deposit please contact the Secretary
  at info@altonadogobedience.org.au or call 0432 745 303 so that other
  arrangements can be made for you.
- Should be Empty:

ALTONA CIVIC OBEDIENCE DOG CLUB INC. Membership Form

MEMBER DETAILS

Dog/s Vaccination Certificates

General

SIGNED:

FOR JUNIOR MEMBERSHIP: