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:__________2010
Name/s &
Address as
it should appear on mailings:
Names/s:_______________________________________________
Street:__________________________________________________
City:________________________State:_______Zip:____________
Day
Phone:______________________Eve. Phone:_______________Cell:____________
*EMAIL ADDRESS:_________________________ (Important)
Web
Page:____________________________
Kennel
name, if any:_____________________________
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_____________ *Use reverse
side if needed
Suggested dues are $15 USA, $20 outside USA. Feel
free to give only what you can.
+Dues for
the year of July 1st, 2010 - July 1st, 2011:___________
+ Raffle tickets- S K-MÕS ÒPUPPIES IN A
BASKETÓ drawing - 6 for $10:____________
+ Poster – The BakersÕ Dozen,
$30:_____________
+ Poster – Twin Towers Tight Rope,
$30:_____________
+Poster -
Kiafrika Azima/Basenjis Ôn Da Hood, $20:____________
+Poster - Kiafrika Azima 2/Babies Ôn Da
Hood, $20:_________
+Poster
– Lunetta/Kamen BHE Quilt Poster, $30___________
+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
Constitution, By-laws,
Roster, on request.
The Rip Van Wrinkler is
published quarterly on our club web site.
www.rvwbasenjiclub.org