Membership Application Form
Belleville & District Kennel Club
P.O. Box 20083, Belleville ON, K8N 5V1
Name : 
Address : 
Address Line 2 : 
City or Town : 
Province : 
Postal Code 
Phone 
Email 
Breed(s):
Interests:
 Conformation:  Obedience:  Agility:  Field:  
Other (please specify):
Single:
 $20.00 HST included
Family:
 $25.00 HST included
HST Reg. No.
128759206 New:  Renewal:

Send Cheque or Money Order to: Treasurer: Shelly Lyck
c/o: Bellville & District Kennel Club, P.O. Box 20083, Belleville ON, K8N 5V1

For Club Use: