WEIMARANER CLUB OF SOUTH AUSTRALIA INC.
APPLICATION FOR MEMBERSHIP & MEMBERSHIP RENEWAL 2006/ 2007
NAME(S): ..................................................................................... DATE: .......................
ADDRESS: .................................................................................... POSTCODE .................
TELEPHONE: ...........................….... EMAIL: ..................................................................
I/We hereby apply for NEW MEMBERSHIP/ MEMBERSHIP RENEWAL Signature/s ..........................................
YOUR INTERESTS: Showing, Obedience , Tracking, Pet / Companion, Retrieving / Field Trials, Agility,
Other ...................………………
MEMBERSHIP FEES: (Please circle desired membership type ).
RENEWAL: Double $25.00 Single $20.00 Pensioner $18.00
NEW: (plus a car sticker) Double-$30.00 Single-$25.00 Pensioner $23
CAR STICKERS AVALIBABLE: $3.00 each
FINANCIAL YEAR: 1st October to 30th September
DETAILS OF WEIMARANERS OWNED (please complete to the best of your knowledge)
Pet Name: .................................................................. D.O.B. ...................... Sex: .............
Pedigree Name .............................................................. Tattoo Number: .............................
Pet Name: .................................................................. D.O.B. ...................... Sex: .............
Pedigree Name .............................................................. Tattoo Number: .............................
Pet Name: .................................................................. D.O.B. ...................... Sex: .............
Pedigree Name .............................................................. Tattoo Number: .............................
Microchip Number.............................................................
APPLICATION / RENEWAL FOR STUD DOG & BREEDERS REGISTER
STUD DOG REGISTER (fee $5.00 per Stud Dog) 1st October to 30th September
Name of Stud Dog ..............................................................................................................
Sire ................................................................................................................................
Dam ...............................................................................................................................
Whelped ........................... Hip Score (ie 3:3) .......... Copy of Hip score report provided to WCSA Inc
Owner(s) .................................................... Telephone .....................................................
Address ......................................................................................... Postcode ..................
BREEDERS REGISTER (fee $5.00 per Kennel Prefix ) 1st October to 30th September
Kennel Prefix ................................…........... Owner(s) ......……...........................................
Address ......................................................................................... Postcode ...................
Telephone ................................…............... Email ...........................................................
Web Page Address.............................................................................................................
If you have Broadband and wish to have the Newsletter emailed YES / NO .
If yes please add email address if diffrent to above .................................................................
RETURN FORM TO: The Treasurer, 18 CLARENCE AVE, KLEMZIG, SA 5087 _
