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Membership applied for: Single: $25.00 Couple: $40.00 Donation:

Total amount submitted

Name(s)*

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone*

Cell

Email Address*

General Information (Please give a brief summary (use other side if necessary)

1) Do you presently own a bull terrier (please list Number, sex, and age)

2) Please list all your current pets, include age and breed

3) Would you like to be actively involved in the Club’s rescue activities such as

Fostering

Yes

Conducting home visits in your area?

Yes

4) How did you hear about our club?

5) Would you be willing to serve on a club committee?

Yes

6) Do you have a special area of interest?

I/we, the undersigned, would like to become a member of the Bull Terrier Rescue Club of Southwest Florida and promise to abide by the bylaws and constitution of the club.

Signatures

Applicant1

Applicant 2

For Club Use only

Check

Cash

Date Received

Please mail to Treasurer Joan Spangler 10533 Tupper Cay Drive San Antonio, FL 33576

Phone

This field is for validation purposes and should be left unchanged.

Bull Terrier Rescue Club of Southwest Florida, Inc.

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