Club Membership

Chihuahua Club of SA Inc.
Club Membership Registration/ Renewal Form

Memberships are due for renewal 1st October of each year prior to the Annual General Meeting. Reminders will be posted on the website and facebook page.

Payments will not be accepted without a completed form either online or via mail.

Physical receipts will only be posted upon request below, incurring a postage fee.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityPost Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Prefix of Breeder of your Chihuahua/s
Registration/ Renewal*

RegistrationRenewal
Membership Detail Fees*

$15 Single Membership$25 Double MembershipComplimentary under 17 years of age$2 Postage Fee for physical receipt of paid membership
Junior Date of Birth

DayMonthYear
Parent/ Guardian Signature

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I/We submit this Membership Registration/ Renewal to the Chichuahua Club of SA Inc. and agree to be bound by the Constitution, Rules & By-Laws and the Club and uphold the Rules & Regulations of the South Australian Canine Association (Dogs SA) for the duration of this Membership and indemnify this Club, Committee and Members against any claims in respect to injury, loss or damage sustained by me/us during participation in any Club activities.
Signature*

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Date

DayMonthYear
Date
Bank Details

Bank: Westpac Banking Corporation (Westpac)

BSB: 035 053

Account: 187 446

Payment Reference: Above Surname

Email: chihuahuaclubofsa@gmail.com
Chihuahua Club of SA Inc.
PO Box 228, Kilburn North, SA 5084
Should be Empty:

Chihuahua Club of SA Inc.