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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.

I/we agree that it is not the purpose of this club to adopt out or to foster any animal for fighting in or out of the pits, nor will this type of activity be tolerated by this Club. I/we do not advocate or participate in any form of inhumane treatment of any animal, which includes dog fighting, pitting, rolling, or any activity of such nature.

Signatures

Applicant1

Applicant 2

For Club Use only

Check

Cash

Date Received

Please mail to Treasurer Joan Spangler 13145 Thoroughbred Dr. Dade City Fl. 33525

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Bull Terrier Rescue Club of Southwest Florida, Inc.

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