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:__________________2011
Name/s &
Address as
it should appear on mailings:
Names/s:_______________________________________________
Street:__________________________________________________
City:________________________State:_______Zip:____________
Phone:______________________
Cell:____________
*EMAIL ADDRESS:_________________________
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, 2011 - July 1st, 2012:___________
+ Raffle tickets- 1. A 1954 hardcover
edition, with original, clean, dustcover, of "Good-bye My Lady," by
James Street. 2. A signed 1978 copy, with
notes in the back, of "The Basenji Illustrated," by Robert W.
Cole. 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
The Rip Van Wrinkler is
published quarterly on our club web site ~ www.rvwbasenjiclub.org
(Constitution, By-laws,
Roster, on request)