The Great Dane Club of Victoria INC
		(Affiliated with the Victorian Canine Association Inc.)
Application for MEMBERSHIP OR RENEWAL (please circle) Single/Double/Family (please circle)
		Please print this form, complete it and send it with your payment to:	Treasurer Michelle Martin 89 Smythe Street Portarlington Vic 3223 Email

Name: (to be completed by each member joining)

Mr. / Mrs./ Ms / Miss……………………………………………………….

Mr. / Mrs. / Ms. / Miss……………………………………………………...

Address:…………………………………………………………………….

………………………….......…State: ...................... Postcode…………….

Telephone………………………........…Fax………………............……….

E-Mail……………………………………………………………...……….

Occupation/s…………………………………………………………….…..

Members interests; eg Showing,obedience etc…………………….…….....…

VCA Membership No (if applicable)……………………………………....…

Kennel Prefix (if applicable)…………………………………………….....….

I agree to abide by the rules of the Great Dane Club of Victoria Inc.
(Rules can be viewed by contacting the Club Secretary)

Signature………………………………………………………………….….

Signature……………………………………………………………………..

Signature………………………………………………………………….….

Date.................................

Fees: Joining Fee $5.00 (once off), Single: $20.00 P.A., Double: $25.00 P.A., Family: POA

RENEWALS DUE: 31st DECEMBER OF EACH YEAR

Please make cheques/money orders payable to The Great Dane Club of Victoria Inc