Application For Membership

 

1) Your Name & Address (BLOCK CAPITALS PLEASE)
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Postcode:	Tel:
Please note that we store Membership details on computer in order to assist with mailing. [ ] Tick if you do not wish to have your name & address held on computer.
2) NEW MEMBERS ONLY: I wish to become a member & am sponsored by two members:
Name:................................................ Name:................................................	Signature:.................................................. Signature:..................................................
3) EITHER enclose your Membership Subscription OR complete the Standing Order Form.
[ ] I enclose £4.00 Single Membership [ ] I enclose £6.00 Joint Membership	[ ] I wish to pay by Standing Order
4) Please state the breed of Dachshund(s) you currently own:
[ ] Smooth [ ] Long [ ] Wire	[ ] Min/Smooth [ ] Min/Long [ ] Min/Wire
I agree to abide by the Kennel Club's mandatory Code of Ethics and the Southern Dachshund Association's Code of Ethics.
Signed:............................................	Date:..........................................

Please return this Form to the Hon. Secretary:

Mrs S Ergis

15 Scott Close, Wallisdown, Poole, Dorset. BH12 5AX

If you wish to pay by Standing Order please complete the Form below and send it to your Bank/Building Society.

SOUTHERN DACHSHUND ASSOCIATION

Please set up a Standing Order payable to

The Southern Dachshund Association, as detailed below.

 

Your Name & Address (BLOCK CAPITALS PLEASE)
Postcode:	Tel:

This instruction cancels any previous Standing Order.

 

Details of your Bank/Building Society Account:
Your Account Sort Code (e.g. 40-25-67)
Your Account Number (to be debited)
Please pay to the Account of Southern Dachshund Association  Lloyds Bank Plc, 45 High Street, Maidenhead, Berks. SL6 1JS Account No. 0923239, Sort Code 30-95-36 The sum of...
[ ] £4.00 Single Membership	[ ] £6.00 Joint Membership
...and subsequently on the 1st January each year until cancelled by me in writing.
Signed:..........................................	Date:......................................

Please return this Form to your Bank.