I/We wish to become Members of the Northern Counties Shih Tzu Club .

1. Membership Required Price Quantity Total Single £5.00 £ Joint Membership £7.00 £ Junior Membership £3.00 £ Overseas Membership £7.00 £ Total £ Payable MEMBERSHIP APPLICATION & RENEWAL FORM 2013 I/We wish to become Members of the Northern Counties Shih Tzu Club. Name: Title………...... First Name(s)…………………………......Surname…......................................………………............. Address: ………………………………………………………………………………….................................................................. Post Code: ………....................... Telephone No.: …………………………………………………………………………………. Kennel Affix: …………………………………………………………………………………………………………………………….. Email : ……………………………………………………….. ………………………………………………………………………….. New Members Only Proposer Name :…………………………………………………………............................................................(block capitals) Proposer Signature :……………………………………………………………………………………………………………………. Seconder Name :……………………………………………………………………………………………...……...(block capitals) Seconder Signature :……………………………………………………..................................................................................... (Both Proposer and Seconder must be current Northern Counties Members) Please take time to complete the following short questionnaire:- Are you are per owner Breeder Exhibitor (please tick all that apply) How many Shih Tzu do you own? Dogs Bitches. What other Breed Clubs do you belong to:…………………………………………………………….................................…... Do you own or breed any other KC breeds (if yes which ?) ……………………………………………………………………. Are you on any Judging List ? (If yes please list)………………………………………………………………………………… I/we enclose a cheque for £___________ payable to NORTHERN COUNTIES SHIH CLUB (N.C.S.T.C.). If accepted as a Member, I/we accept to be bound by the Northern Counties Club Rules ad Regulations and also its Code of Ethics, copies of which I/we have read and understood. Signed……………………………………………… Signed………………………………………………Date……………………………… Send this form to: Honorary Secretary, Jackie Bowns, 215 Watling Street, Grendon, Atherstone, Warwickshire, CV9 2PJ