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, Comments