BRITTANY SPANIEL CLUB OF CANADA 2007 Membership Application

Last Name:____________________________________     First Name: ________________________________ Spouse: _______________________________________________________ Mailing Address: _______________________________  City: ____________________________________ Province: ______________________________________Postal Code: ______________________________ Phone (home) : (_____)________________________    Phone (work):________________________________ E-mail address:  ________________________________  Fax: ______________________________________ Do You want to be included on the Breeder's List?:  Yes ____  No ____Kennel Name: _____________________ List Dog's Names and CKC Number:  (use back of form if necessary) Name:____________________________________________  CKC No: _______________________________ Name:____________________________________________  CKC No: _______________________________ Name:____________________________________________  CKC No: _______________________________ Interests:   Show: _____________________  Field Trials: ________________  Obedience: _______________  Field Tests: ________________   Agility:___________________    Hunting: _________________ Other: _____________________________________ "I support the Brittany Spaniel Club of Canada in its aim of promoting and maintaining the dual qualities of the breed as outlined in the CKC breed standard." Signature: _________________________________________________   Date: ______________________ Fees:              Please return this form with the appropriate fee to:                         Brittany Spaniel Club of Canada               $20.00 per family (2 votes)     New: _________                                Kim Brunen              $15.00 single membership   Renewal: _______                                Box 499 Crossfield, AB T0M 0S0