Application for Club Membership

Name


Street Address


State


Postcode/Zip


Country


Phone (include area code)


Email


C.C.C. Membership number
(if applicable)


Prefix/es


Occupation


Name of Dog/s
Registered or Call Name



Choose Membership Type
Full (Family) - $25.00 AUD
Associate - $15.00 AUD
All overseas and interstate memberships are a one off fee.

Payment of fees by cash, cheque or money order to:
The Secretary, ACDSCNQ,
36 Alfred St, AITKENVALE 4814, QLd, Australia,

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