MEMBERSHIP APPLICATION

Please complete this form, print, and mail with a check payable to
Northern Nevada Brittany Club ($30 for each full member & $3 for each associate member)
to: NNBC c/o Yvonne Shanto, 16125 Buffalo Road, Reno NV 89506 - (775) 969-3745
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 ______________________________

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