The Staffordshire Bull Terrier Club of South Australia
Inc
Application for Membership
20.../20...
I/We hereby apply for membership / or renewal of
Membership, of the Staffordshire Bull Terrier Club of South Australia Inc.
Name(s): (Mr,
Mrs, Miss, Ms)
Postal Address:
City:
State:
. Postcode:
Phone No:
..(Home)
.. (Mobile)
.. (Work)
Preferred
Contact: (Circle one) Home Phone Mobile Email
Email Address:
Would you like to
receive your profile via email? Yes/No
Your Kennel
Prefix
.. (if any)
Club Membership
No:
Signature(s): ...................................Date:
Nominated By:
..
(Member of the
Staffordshire Bull Terrier Club Inc)
Signature of Nominator: .. ........Date: ..........
Membership Required: Membership Renewal is payable the 1st September each year
(Please
Circle) SINGLE $15 / year FAMILY/DUAL $25 / year JUNIOR $5
/ year
(Family Membership2 Adults + any children under 18
years of age)
Please Return Form
& Payment to
Secretary (SBTC
of SA)
SBTCSA
12 Moulds Cres,
Smithfield SA 5114