Black Russian Terrier Club of America, Inc

Black Russian Terrier Club of America

 

Member(s) Name: ________________________________________________________

 

Address:_______________________________________________________________

 

City, ST, ZIP:___________________________________________________________

 

 

Renewal Membership Dues:

Black Russian Terrier Club of America, Inc dues are due now for the membership year of  20___ . Any dues received after March 1st, 20___ is a lapse in membership and would need to reapply.

Please get your dues in before March 1st, 20____ to avoid lapse in membership

 

Please refer to your bylaws - Article I-Membership regarding membership status.

Anyone who does not own a Black Russian Terrier dog can only be an Associate Member.

 

Dues are as follows:

Individual Membership - $25.00 U.S. Funds per year - open to any owner 18 years or older & owns a registered Black Russian Terrier

Family Membership - $25.00 U.S. Funds per year plus $5.00 for each additional family member over 18 years of age & owns a registered Black Russian Terrier. Example: Fee for Husband and Wife $30.00, Fee for Husband, wife and child living in the same household $35.00 etc.

Associates Membership - $25.00 U. S. Funds per year open to non owners (does not own a registered Black Russian Terriers) No voting rights

 

Please make check payable to Black Russian Terrier Club of America, Inc.

Please make any corrections to keep your information updated, sign & return form with payment to June Charles

 

Trophy Donation: $___________

 

Membership Fee Enclosed $                  Individual (     )    Family   (    )    Associates   (     )  (please check one)

 

Total amount enclosed: $_____________     

 

If Family Membership Please list other members for Family membership:

Name:

Home Phone #: 

Fax #:                                                                      

Kennel Name:   

Email:

Website:  

 

Do you still own a registered Black Russian Terrier: YES (   ) NO(   ) How Many?______

 

Do you approve of your contact information being posted on: Website: Yes (    ) No (    ) Newsletter: Yes (    )  No (     ) 

Any Publication: Yes (    ) No (   ) (please check)

 

I/We agree to abide by the By-laws as adopted by the Black Russian Terrier Club of America, Inc. and that all the above information is accurate to the best of my knowledge.

 

 

Please mail renewal application and dues to:

June Charles

605 Magnolia Road

Lumberton, MS 39455

                         

Black Russian Terrier Club of America, Inc. -  Thanks you for your support!