THE DOMINION SAMOYED CLUB (INC)

President:
Sandra Stewart
239 Gardiners Road
Springbank RD1
Rangiora, North Canterbury.
Ph 03-312-5030

Secretary:
Carol Fleming
243 Burnham Road
Burnham PDC
Burnham 7600
Ph 347-6738

Treasurer:
Mary Wells
87 Walkers Road
RD7
Rolleston 7677
Ph 347-2406

SUBSCRIPTION FORM
(1 January 31 December annually)

NAME

...............................................................................

ADDRESS

...............................................................................
..................................................................................

PHONE

...................................

EMAIL ....................................

Please post or hand to the Treasurer, 87 Walkers Road, RD7, Rolleston 7677
or you can deposit it direct into the Clubs Westpac Bank Account No. 03-1700-0120462-00
(No cash through the post please!)

Single membership
Double membership
Overseas membership
Junior membership
(non-affiliated family)
Junior membership
(under 17 years of ageaffiliated family)

$20.00
$22.00
$25.00
$16.00

Stud Directory
Breeders Directory
Show Sponsorship
Sam Rescue
Other

$ 3.00
$ 3.00
$
$
$
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TOTAL

$
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$ 1.00

Tell us your dog/s names