The Country Griffon Bruxellois Club of NSW Inc

The Country Griffon Bruxellois Club of NSW Inc

MEMBERSHIP FORM
I wish to:*

Join The Country Griffon Bruxellois Club of NSWRenew my membership of The Country Griffon Bruxellois Club of NSW
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*

YesNoI am a Member of another Canine Body
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*

I am a Breeder of Griffon BruxelloisI am an Exhibitor of Griffon BruxelloisI am competing in Dog Sports (Rally, Obedience, DWD or Agility) with my Griffon BruxelloisI am a Griffon Bruxellois Pet OwnerI am hoping to own a Griffon Bruxellois one day
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*

I confirm that I have read and agree to abide by the Rules, Regulations, Codes of Ethics and Conduct of The Country Griffon Bruxellois Club of NSW.
Membership is $10.00 per person for the financial year. Please advise your preferred payment method*

I will pay via Direct DepositI will pay via Debit/Credit Card or PayPal ($1.00 fee per year applies)I will pay by Cash to a Member of Committee
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 or PayPal (includes fees)*
prevnext( X )
Financial Year (x1)
2024-2025

$11.00AUD



Financial Years (x2)
2024-2025, 2025-2026

$22.00AUD



Financial Years (x3)
2024-2025, 2025-2026, 2026-2027

$33.00AUD



Financial Years (x4)
2024-2025, 2025-2026, 2026-2027, 2027-2028

$44.00AUD



Financial Years (x5)
2024-2025, 2025-2026, 2026-2027, 2027-2028, 2028-2029

$55.00AUD



Total

$0.00AUD
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The payment is ready! It will be completed once you submit the form.
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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