Hudson Valley Brittany Club Membership Application

HVBC MEMBERSHIP APPLICATION
Please complete this form, print, and mail with a check payable to Hudson Valley Brittany Club ($30 for each full member & $3 for each associate member) to: Nancy Morabito, PO Box 28, So. Bethlehem NY 12161 - (518) 767-2656
Application Type:	[___] New Applicant [___] Membership Renewal [___] Associate Membership [___] Gift Membership

This is a Gift Membership for:	____________________________________________________________
Address	____________________________________________________________
City, ST, Zip	____________________________________________________________
Phone	____________________________________________________________
E-Mail	____________________________________________________________

Your Name(s)	____________________________________________________________
Address	____________________________________________________________
City, ST, Zip	____________________________________________________________
Phone	____________________________________________________________
E-Mail	____________________________________________________________

Brittanys You Own:	____________________________________________________________
Primary Interests:	[___] Hunting [___] Field Trials [___] Hunt Tests [___] Dog Shows
	[___] Obedience [___] Agility [___] Pet [___] Other___________________
SIGNATURE(S)	____________________________________________________________
	____________________________________________________________
DATE	______________________________