Membership Application
NB: it is possible to pay over the internet, the Club account details are below, BUT, you must CLEARLY label
what your deposit is for, in Capital letters in the transfer form please:
Name of Account: Griffon Bruxellois Club of NSW Inc
BSB 032376
account number 273281
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The Griffon Bruxellois Club of NSW Membership Application/Renewal Form.
Please complete this form and return it to the Secretary:
Mrs Bridget Power, 37 Queen St., Warialda, NSW, 2402
Name:… ………………………………………………………………………..
Address:……………………………………………………………………….
Email:… …………………………………
Phone:…………………………………………
Website (if applicable):…………………………………………
Membership No (if any):…………………………………….
Prefix (if applicable):………………………………….
Number of Griffons owned:…………………………………….
Names:……………………………………………………………………………………………………
………………………………………………………………………………………………………………
I enclose cheque/ postal order of $25.00 (single) or $30 (dual) for membership
Signed _________________________ Date: __________________