Cairn Terrier Club of Victoria - Membership application

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	President	Ms Amy Jonas
		0402 009 770

	Secretary	Mrs Margaret Dixon
		03 9830 1590

Name/s	____________________

Address	____________________

	____________________	Post Code ______

Phone	____________________

Email	____________________

VCA/Other State Member Number	____________________

Name of Cairns	____________________

Breeder of your Cairns	____________________

* Includes joining fee $2.50.

# One Adult (parent/guardian) must be a member in order for a Junior membership to be taken out by children.

I/We enclose a cheque/money order for the amount of $__________ made payable to the Cairn Terrier Club of Victoria.

Please complete this form and send with your cheque/money order to:

The Treasurer

Mr G Ferbrache

242 Edward Road

Chirnside Park VIC. 3116

03 9735 4117