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Border collie club of Northern California
Bccnc
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MEMBERSHIP TYPE Please choose one of the following membership types:
__Single Membership ($25) __Household Membership ($35) __Junior ONLY Membership ($15)
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MEMBER’S INFORMATION
Last Name_____________________________ First____________________________ M.I.___________
Street Address Apt/Unit #_________________________________________________________________________________
City ________________________________________State _________________ZIP________________
Phone__________________________ E-mail Address________________________________________
Website______________________________________________________________________________
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Border Collie Club of Northern California www.BCCNC.org |
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Membership Signature Date
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Mail check and completed application to: Susan Joder, 134 Country Ranch Rd., Fernley, NV 89408
, Minden, NV 89423 |
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DELIVERY OPTIONS Please choose one of the following options below on how you would like to receive BCCNC’s meeting notices and newsletters:
__I wish to receive club meeting notices and newsletter via e-mail (e-mail address required) OR __I wish to receive club meeting club meeting notices and newsletter via regular mail (U.S. Postal Service) |
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ADDITIONAL HOUSEHOLD MEMBERS (FOR HOUSEHOLD MEMBERSHIP ONLY)
Last Name_____________________________ First____________________________ M.I.___________
Last Name_____________________________ First____________________________ M.I.___________
Last Name_____________________________ First____________________________ M.I.___________
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BREED RESCUE DONATION
Do you want to make a donation to Border Collie Rescue? __Yes __No If yes, how much?__________
NOTE: You may add the amount you wish to donate to the total of your membership dues.
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