Rip Van Wrinkle Basenji Club
Membership Renewal
Dues are due by July 1st. Only one notice will be sent. Please note any changes in spaces below.
DATE:___________________2014
Name/s & Address as it should appear on
mailings:
Names/s:_______________________________________________
Street:__________________________________________________
City:________________________State:_______Zip:____________
Day
Phone:______________________Eve. Phone:_______________Cell:____________
*EMAIL
ADDRESS:_________________________ Website___________________________
Specific interests (obedience, agility, lure coursing, LGRA, NOTRA, breed, Rally, therapy dog, cuddling, etc.) __________________________________________________________________________________
Other club memberships_______________________________________________________________
Dogs:
Name__________________________________Date of Birth___________
Name__________________________________Date
of Birth ___________
Name__________________________________Date
of Birth ___________
Name__________________________________Date
of Birth_____________
Suggested dues are $15
USA, $20 outside USA. Feel free to give only what you can. Raffle drawing is
June 20th.
*Dues for the year of July 1st, 2014 - July
1st, 2015:___________
*Raffle tickets- 4 prizes - Basenji Stuffed Animals - 6 for $10:____________
*Contribution for equipment,
Rescue fund:___________
Total:______________
Make checks payable to the Rip Van
Wrinkle Basenji Club.
Mail to:
Karen Sahulka, 205 Plochmann Lane,
Woodstock. NY 12498
The Rip Van Wrinkler is
published quarterly on our club web site.
www.rvwbasenjiclub.org (Constitution, By-laws, Roster, on
request.)