Name *

First Name

Last Name

Name

(in case of joint membership)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

I / We named above agree to abide by the Japanese Shiba Inu Club of Great Britain's Rules and Constitution *

Agree

Proposed by: *

Proposer must be a fully paid up member for a minimum of the twelve preceding calendar months.

First Name

Last Name

I, the proposer named above, is in agreement with the proposal of the individual(s) detailed above. *

Agree

Seconded by: *

Seconder must be a fully paid up member for a minimum of the twelve preceding calendar months.

First Name

Last Name

I, the seconder named above, is in agreement with the proposal of the individual(s) detailed above. *

Agree

Do you agree to your address being published? *

Yes

No

Do you agree to your email address being published? *

Yes

No

Do you agree to your telephone number being published *

Yes

No

How do you prefer to be contacted? *

From time to time, the club may send information to members. Please select your preference for receiving communication below.

Email

Post