NAME: ___________________________________________________________________________________________
ADDRESS: ________________________________________________________________________________________
CITY: __________________________________________
STATE: ________ ZIP: ____________- __________
PHONE (please include area code): EVENING:
______ - ______- __________ DAY: ______-
______- __________
FAX: ______- ______- __________ E-MAIL: _____________________________________________________
OCCUPATION: _____________________________________
REFERRED BY: ___________________________
If Family Membership, list name(s) and relationship
of femily member(s):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
ANNUAL MEMBERSHIP DUES:______Individual Membership
$15.00 (one vote) ______Family Membership
$20.00 (two votes)
____ Check here if you are including a donation
for Breed Rescue. Please accept my donation
of $__________ for Breed Rescue.
Please mail this form with your check made
payable to GSPC of CA to:
Laura Hansen
2644 Monte Vista
El Cerrito, CA 94530
_________________________________________________________________________________________________________
| Are you interested in ? yes / no / maybe |
Are you willing to help ? yes / no / maybe |
|
| Field Trials | ||
| Walking Field Trials | ||
| Hunt Tests | ||
| Conformation Shows | ||
| Chukar Shoot-Out | ||
| Salmon Fishing Trip |