Membership Application Form Please print all details. All membership applications must be accompanied by a current vaccination certificate for each dog. Your membership is not active until we have received your payment. MEMBERS DETAILS Home Address State Postcode Contact Phone Number Email Address First Name (of primary handler) Membership Name (Surname) Other Names in Family Membership Name (DoB if<16) Vikings Membership Number (if applicable) DOGS DETAILS Sex Vaccination Date of Dog’s Name Breed Handler’s Name (M/F) Date Birth ENROLMENT DETAILS Session Session 1 Session 2 Session 3 Please mark Session 4 Session 5 Other activity appropriate box Additional Dog Grounds use only Agility Flyball Rally-o Preferred training time (this only applies if you will be in a beginners obedience class) Sunday 9:00 am to 10:00 am Tuesday 7:00 pm to 8:00 pm – – I agree to accept the responsibility for all actions of my dog while attending any event conducted by the members of the Tuggeranong Dog Training Club Inc. I understand that the Tuggeranong Dog Traning Club Inc. or any of its officials do not accept any responsibility for any injury that is occasioned to any member of my family or any dog(s) and agree to indemnify them against any action at law. I agree to ensure that my dog(s) will be maintained under control, that they are immunised and will maintain immunisation while they are attending club activities. I further agree to abide by the rules and constitution of the club. Signed (by Adult) Date SUBMITTING YOUR APPLICATION Cheques and money orders should be made payable to Tuggeranong Dog Training Club Inc. In Person: By Post: Online: Visit the TDTC Office on Tuggeranong Dog Training Club Email your completed forms and training days only PO Box 1803 vaccination certificate to TUGGERANONG ACT 2901 Pay by:cheque, order, Pay by: cheque or money order Pay by: direct bank transfer credit card, EFTPOS or cash BSB: 062 914 Account: 10112729 Ref: Surname & dog’s name New Membership Renewal Extra dog Activity $190 for 12 months $120 for 12 months $50 $50 TDTC Fees (TDTC memberships are for 12 months from the joining/renewal date)
Membership Application Form Please print all details. All membership applications must be accompanied by a current vaccination certificate for each dog. Your membership is not active until we have received your payment. MEMBERS DETAILS Home Address State Postcode Contact Phone Number Email Address First Name (of primary handler) Membership Name (Surname) Other Names in Family Membership Name (DoB if<16) Vikings Membership Number (if applicable) DOGS DETAILS Dog’s Name Breed Sex (M/F) Vaccination Date Date of Birth Handler’s Name ENROLMENT DETAILS Session Session 1 Session 2 Session 3 Please mark appropriate box Session 4 Session 5 Other activity Additional Dog Grounds use only Agility Flyball Rally-o Preferred training time (this only applies if you will be in a beginners obedience class) Sunday – 9:00 am to 10:00 am Tuesday – 7:00 pm to 8:00 pm I agree to accept the responsibility for all actions of my dog while attending any event conducted by the members of the Tuggeranong Dog Training Club Inc. I understand that the Tuggeranong Dog Traning Club Inc. or any of its officials do not accept any responsibility for any injury that is occasioned to any member of my family or any dog(s) and agree to indemnify them against any action at law. I agree to ensure that my dog(s) will be maintained under control, that they are immunised and will maintain immunisation while they are attending club activities. I further agree to abide by the rules and constitution of the club. Signed (by Adult) Date SUBMITTING YOUR APPLICATION Cheques and money orders should be made payable to Tuggeranong Dog Training Club Inc. In Person: By Post: Online: Visit the TDTC Office on training days only Tuggeranong Dog Training Club PO Box 1803 TUGGERANONG ACT 2901 Email your completed forms and vaccination certificate to Pay by:cheque, order, credit card, EFTPOS or cash Pay by: cheque or money order Pay by: direct bank transfer BSB: 062 914 Account: 10112729 Ref: Surname & dog’s name TDTC Fees (TDTC memberships are for 12 months from the joining/renewal date) New Membership Renewal Extra dog Activity $190 for 12 months $120 for 12 months $50 $50
New-Memb-App-Form-Jan2018.docx