The Collie Rough and Smooth Club of Queensland (Inc.)
Application for Membership

Please fill out this form, print it and forward it to the Secretary with the relevant fees.

Name    

Address

Post Code     Phone

Kennel Prefix

C.C.C. Membership No.

Email Address

Membership type

 ($20)
   ($25)*

I/We hereby apply for membership renewal of the Collie Rough and Smooth Club of Queensland Inc., for the year _________.
We agree to be bound by the rules and regulations of the Club, and the Constitution, Rules and Regulations of the Queensland Canine Control Council (C.C.C.).
  *A Dual Membership signifies any 2 people living under the one roof.
Do you wish to receive your newsletter by email or by ordinary mail ?

Signature of applicant(s)

Signature of Nominee

Name of Nominee      

(Nominee must be a financial member of the Collie Rough and Smooth Club of Qld, Inc.)

Please forward the completed form to:- The Secretary, Timothy Thomas
P.O Box 187, Clayfield, Qld 4011 Ph:- 07 3662 6445

 

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