Please complete this form, print, and mail with your check
payable to
Northern CA Brittany Club ($30 for each full member & $3 for
each associate member)
to: Debbie Coyle, 8411 Potosi Road, Redding CA 96001-9553
Debbie may also be reached at (530) 242-5801 or gmbrittanys@sbcglobal.net
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| 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 |
______________________________ |
