Application for Membership to
The Midland Rottweiler Club
PLEASE SEND THE COMPLETE FORM TOGETHER WITH THE APPROPRIATE FEE (IF APPLICABLE) TO: HON. MEMBERSHIP SECRETARY, Mr Richard Chaffe, 84 Stourbridge Rd,Bromsgrove,B61 OA1, 01527 877501


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POST CODE.........................................................TEL.No...............................................
 PLEASE STATE HOW MANY DOGS YOU OWN, WHICH BREEDS & KENNEL CLUB REGISTERED NAME IF KNOWN
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NAME, ADDRESS & SIGNATURE OF MEMBER WHO IS PROPOSING YOU
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NAME, ADDRESS & SIGNATURE OF MEMBER WHO IS SECONDING YOU
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MEMBERSHIP FEES : SINGLE £ 10.00, HUSBAND, WIFE & TWO FAMILY MEMBERS £12.00, OVERSEAS MEMBERS. £25.00
RENEWAL DATE IS 1ST OCTOBER ANNUALLY. IF THIS SUBSCRIPTION IS SENT AFTER THE 1ST JULY YOUR SUBSCRIPTION WILL NOT BE RENEWABLE UNTIL THE 1ST OCTOBER OF THE FOLLOWING YEAR.

PAYMENT METHODS : BY CHEQUE OR STANDING ORDER. IF YOU WISH TO PAY BY STANDING ORDER PLEASE COMPLETE THE SECTION BELOW.

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STANDING ORDER MANDATE

TO........................................................BANK plc, ADDRESS..............................................
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PAY YORKSHIRE BANK, ALFRETON BRANCH - BANK SORT CODE 05 02 11 - ACCOUNT No 47985727, FOR THE CREDIT OF THE MIDLAND ROTTWEILER CLUB.
THE SUM OF£ 10.00 £12.00 £25

AMOUNT............COMMENCING ........... AND ANNUALLY THEREAFTER EVERY 1ST OCTOBER

NAME.............................................................. ADDRESS...................................................
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ACCOUNT No....................................................SIGNATURE.................................................

PLEASE SEND THE COMPLETE FORM TOGETHER WITH THE APPROPRIATE FEE (IF APPLICABLE) TO: HON. MEMBERSHIP SECRETARY, Mr Richard Chaffe, 84 Stourbridge Rd,Bromsgrove,B61 OA1, 01527 877501