PCCI NO. THE PHILIPPINE CANINE CLUB, INC. P.O. Box 281 Quazon City Central Past Office, NIA Read, Q.C, Room A206 Hiferest Condominium 1616. Rodriguez Sr. Avenue Gubao, Quezon City, Philippines Tel, Nos. 721-8345: 721-7152 MEMBERSHIP CARD Print FullName Test (Complete Home. Address Date of Birth MMDDIYY Citizenship [7] rip Educational or to ‘Ey Atcerent! — [)itonsctotor tower [] estan or Higher Dlothors (pis speci) Emplayment [ Jerate L]soremploved | Employer's Name Dceversmant EF] nis Office Name Employment Address Place of Birth: |covege /Cetiage Level Office: Phone: E-mail Address: Would you like to partcipatein ourdog shows? Yes io Gan we call yout help \ apply to become @ MEMBER of the Philippine Canine Club, Incorporated, and in so doing | expressly acknowledge the Jurisdiction of the Philippine Canine Club, Inc. (PCC!) as the SOLE governing body in the Republic of tha Philippines with respect to all canine affairs and | agree to abide by all Rules, Regulations, Resolutions and By-Laws of the Philippine Canine Club, Ine, and/or its Board of Directors, which may be in force during the period of membership. INTAND SIGNABOVE PRINT AND SION ABOVE PRINT AND SIGN ABOVE PLEASE USE BLACK PEN AND SIGN WITHIN BOX PHILIPPINE CANINE CLUB, INC. will recognize any one signature on the above for registration of dogs and other transactions under my name