Membership Type Membership Type New Member Renewal of Membership

I/we agree to pay the member subscription as per the scale below which is due 1st July each year. I/we agree to pay the member subscription as per the scale below which is due 1st July each year. Yes No

Payment For Payment For Beginners 4 week course (Includes Joining Fee, Membership & 4 x Ground Fees) $85 Initial joining fee $25 Single membership fee $25 Dual membership fee $30 Weekly Ground Fees $4

Annual Renewal Options Annual Renewal Options 12 monthly Instructors membership $100 incl. Renewal & Ground Fees 12 monthly General membership $160 incl. Renewal & Ground Fees

Paws Awhile Magazine Paws Awhile Magazine Please Post ($14 postage per annum) I will collect Paws Awhile Email Address for Paws Awhile

Email Address

Is your dog vaccinated against: (proof of vaccination is required) Is your dog vaccinated against: (proof of vaccination is required) Hepatitis Parvovirus Distemper Kennel Cough

Title TitleMrMrsMissMs

Full Name

Address

Phone Number

Email Address

Are you a member of Dogs NSW? Are you a member of Dogs NSW? Yes No

Is your dog registered with Dogs NSW? Is your dog registered with Dogs NSW? Yes No

Dog Breed

Pet Name

Sex

Date of Birth

Class

Where did you hear about MMW

Pensioner Discount Applicable Pensioner Discount Applicable Yes No

In submitting this form I/we indemnify the Club against any claim for damages for personal injury, however caused.