The Country Griffon Bruxellois Club of NSW Inc

The Country Griffon Bruxellois Club of NSW Inc

MEMBERSHIP FORM
I wish to:
Date

DayMonthYear
Date
Name

First NameLast Name
Email
example@example.com
Mobile Number

Country CodePhone Number
Home Address

Street Address

SuburbState

Post CodeCountry
Are you a Member of DogsNSW
Please provide your DogsNSW Member No
What is the name of the Canine Body you are a Member of?
Please provide your Membership No of this Canine Body
Select all that apply
Please tell us your Breeder Prefix
Please tell us the Breeder of your Griffon Bruxellois
How many Griffon Bruxellois do you own?
Please tell us the names of the Griffon Bruxellois that you own
Please tell us why you wish to join the Country Griffon Bruxellois Club of NSW
Code of Conduct

Constitution
Declaration
Membership is $10.00 per person for the financial year. Please advise your preferred payment method
Direct Deposit
Bank Account Name: The Country Bruxellois Club of NSW Inc BSB: 012-559 (ANZ) Account No: 3890-43729 Reference: Your LAST NAME and the word “MEMBERSHIP”
Upload Screenshot of Direct Deposit if you have paid while completing this Form

Cancelof
Debit/Credit Card/PayPal
https://www.paypal.com/ncp/payment/WN8PNQ4A8RB4W
Click to pay by Debit/Credit Card/PayPal (be sure to return here to click SUBMIT)
Please tell us which Member of Committee you will be paying cash to
You will receive a copy of your responses to the email address you supplied. If you have any queries, please contact the Club Secretary on cgbcnsw@gmail.com
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