White Swiss Shepherd Dog Association of Victoria INC

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Title 1

Given Name(s) 1

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Surname 1

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Title 2

Given Name(s) 2

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Surname 2

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Address

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City

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State

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Postcode

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Phone Number

Mobile Number 1

Mobile Number 2

Email Address 1

Confirm Email Address 1

Email Address 2

ANKC Membership Number 1

ANKC Membership Number 2

Prefix

Date Joined Association

Todays Date

Interests

Junior Members

Title 1

Given Name 1

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Surname 1

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Age 1

Title 2

Given Name 2

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Surname 2

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Age 2

Title 3

Given Name 3

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Surname 3

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Age 3

Membership

Single $15.00 x

Dual $20.00 x

Family $20.00 x

Junior $10.00 x

Associate $0.01 x

Easy Dog Entries Conditions

I agree to the Easy Dog Entries terms and conditions.

I acknowledge that the acceptance of this payment by Easy Dog Entries does not necessarily imply acceptance of the payment by White Swiss Shepherd Dog Association of Victoria INC, which can reject and refund the payment at any time at their discretion.

I acknowledge that any and all refund requests for this payment must go directly to White Swiss Shepherd Dog Association of Victoria INC, and that as a service, Easy Dog Entries is not responsible for deciding whether to refund this payment or not.

Payment

Items Total $0.00
Online Payment Fee $0.00
GST $0.00
Transaction Fee $0.10
Total (AUD) $0.10

Card Number

Expiration Month

Expiration Year

White Swiss Shepherd Dog Association of Victoria INC - Membership Application/Renewal

Junior Members

Membership

Easy Dog Entries Conditions

Payment