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 1st January 2012:
……… x Single Adult Membership
@ £7.50
……….x Joint Adult Membership
@ £12.00
.…..……x Junior (16 yrs & under) @
£1.00
Membership fees renewable yearly on 1st
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,
For SISS
Use:
Membership Approved__/__/__ Payment
received: cheque/cash/PO
£___
Membership card issued __/__/__ Pack sent: Y/N
Entered on database __/__/__