Club Membership Registration Form

Southern Cross Staffordshire Bull Terrier Society Inc - Club Membership

Please complete this form for both NEW Membership and Membership Renewals to ensure details are correct.
Primary Member Name*

First NameLast Name
Renew MembershipNew Membership
E-mail*
Mobile / Phone Number

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

City

Postal / Zip Code
YesNo, just love the breed!No, but looking to add one to the family

Stafford Details

Rows	Dog Name	M/F	Age	Colour	Registry	Registration Number
Stafford 1
Stafford 2
Stafford 3
Stafford 4

Family PetsBreedingSports (Agility, Obedience, Rally-O etc.)Breed ShowingOther
A Friend or colleaugeGoogleFacebookOther
Subscription Type*
Please select your membership type and any additional subscriptions. If you wish to have a stud and/or breeder listing, please provide these details below
Family Membership

Children must be aged between 16 and 21 years inclusive to be eligible
Spouse/PartnerChild 1Child 2
Spouse/Partner Name

First NameLast Name
Spouse/Partner Email Address
example@example.com
Spouse/Partner Phone Number
Please enter a valid phone number.
Child 1 Name

First NameLast Name
Child 1 Email Address
example@example.com
Child 1 Phone Number
Please enter a valid phone number.
Child 2 Name

First NameLast Name
Child 2 Email Address
example@example.com
Child 2 Phone Number
Please enter a valid phone number.
Additional Optional Subscriptions
Stud Directory Details
Dog's Registered Name, Registration Number, Stud Contact Details & LRL Health Testing Status. Please note, we only advertise studs who are registered with DogsNZ and have the relevant health testing as per the LRL. SCSBTS require evidence of the relevant health testing for the LRL, you can upload this below or email this to us.
Stud Directory Health Testing Evidence

Browse Files
Please upload relevant health testing that shows your stud complies with the LRL. Cancelof
Breeders Directory
Kennel Name and Contact Details. Please Note: SCSBTS only advertises kennels registered with DogsNZ and who are current financial members with both DogsNZ and SCSBTS. SCSBTS reserve the right to check the status of your kennel with DogsNZ before approving.
Membership Rules
- Membership is for owners of purebred Staffords, or anyone who has an interest in the Staffordshire Bull Terrier breed.
- The Society's purpose and objectives is for the welfare, well-being and correct image of the Staffordshire Bull Terrier and to educate and support Staffordshire Bull Terrier owners.
- By consenting to be a Member of the Society you agree to abide by the Society's Constitution
Privacy Policy
- We acknowledge that personal information about you is given in trust and confidence, and as such, the privacy and protection of your information is of absolute importance to us. We comply with the Privacy Act 2020 when handing personal information.
- Please see our Privacy Policy.This policy explains how we collect, hold, use, disclose, and protect your personal information. This policy also informs you of your rights in relation to your personal information. If you have any questions about this policy, please contact us at scsbts@gmail.com.
Total Payment Due
Please pay this amount into the SCSBTS bank account provided below
Forms of payment:

Internet Banking:

(BNZ) 02-0772-0331002-000

ACC Name: The Southern Cross Staffordshire Bull Terrier Soci

(include your name and "membership" in the reference fields)

Please ensure payments are made within 2 working days of completing this form
If this is a new membership, your membership application will be reviewed by the Society's Officers as per the club's Constitution.

Once your membership has been approved, we will be in contact.
Donation*
SCSBTS is a fully volunteer run club and any donations go directly to funding activities such as ribbon parades, fun days, championship shows. We appreciate all donations
I have read, and understood the Society's Constitution, and consent to being a Member of the Society.I have read, understood, and accepted the privacy policy for membership.
Primary Member Signature
Signature of Spouse/Partner
Signature of Child 1
Signature of Child 2
Should be Empty:

Southern Cross Staffordshire Bull Terrier Society Inc - Club Membership

Family Membership