The Southern Italian Spinone Society

MEMBERSHIP APPLICATION FORM

I/We apply for Membership of the Southern Italian Spinone Society and I/we agree to abide by the Rules and Regulations once my/our application has been approved and understand that membership may be terminated if I/we fail to do so. I/we agree that my/our membership shall be entered on the Society’s Membership Database, which may be forwarded to the Kennel Club as part of the Annual Returns (if and/or when the Society apply for and gain K.C. approval).

NAME……………………………………………………………………………

NAME……………………………………………………………………………

ADDRESS………………………………………………………………………

………………………………………………………………………………….

Telephone  No. ……………………………. E-mail address…………………..

Fax No. …………………………………….

Signature of proposer………………………………………………………………

Please print name of proposer……………………………………………………...

NB Proposer must be a fully paid up Member of the Society

Subscriptions as at 1^st January 2009:

……… x Single Adult Membership @ £7.50

……….x Joint Adult Membership @ £12.00

.…..……x Junior (16 yrs & under) @ £1.00

Membership fees renewable yearly on 1^st January.

Please make cheques/postal orders payable in sterling to:

The Southern Italian Spinone Society

SIGNED ……………………………….SIGNED…………………………………..

(Please include both signatures if joint application)

Please return this form with payment to: The Membership Secretary, Mr M.D. Wellman, 12 Elizabeth Crescent, East Grinstead, West Sussex RH19 3JA England (Email: martin@southern-spinone.co.uk)

For SISS Use:

Membership Approved__/__/__   Payment received: cheque/cash/PO  £___

Membership card issued __/__/__ Pack sent: Y/N Entered on database __/__/__