MEMBERSHIP - ONLINE FORM

Please complete all areas marked with a star (*) or your form will not be submitted.

* Name:
* E-mail:
* Address:
* City:
* Province/
State:
* Postal/
Zip Code:
* Phone:

I/We, the undersigned, do agree that, if accepted for membership in the Flat-Coated Retriever Society of Canada, I/we will adhere to the Code of Ethics as set forth by the Flat-Coated Retriever Society of Canada, and incorporated into the bylaws of the Society. In the case of electronic application or renewal, I acknowledge my typed signature is a valid replacement for the original.


* Signature:
* Date:

MEMBERSHIP RATES



Memberships are available for 1, 2 or 3 year terms and start/renew on January 1. Early Bird discounts are available to renewals only. All new applications must pay the Regular Rates Per Year. Please see the 2017 membership rates schedules for Canadian Residents or Non-Canadian Residents.

PAYMENT OPTIONS


Cheque
Interact e-Transfer
Credit Card/PayPal

You will be taken to the payment page once your application/renewal has been submitted.

MEMBERSHIP TYPE



Renewal
New Member (see conditions below)

New members must be sponsored by a current member in good standing

Sponsor Name:


Sponsor Phone:


Sponsor Address:


Date of Sponsorship:


Please include a brief paragraph about yourself and dog-related interests:

Information about new members will be published in upcoming issues of our newsletter, Flat-Out


MEMBER INFORMATION



The following questions are designed to keep the Society informed about members and their Flat-Coats.

* Are you a member of the Canadian Kennel Club? Yes      No

* Are you a breeder? Yes      No
   If "yes", what is your kennel name
     Do you wish to be included on the FCRSC breeder list?
      Yes      No
    Do you wish to also be included in the on-line FCRSC breeder list?
      Yes      No
     Are you planning a litter within the next 2 years?
      Yes      No

Be sure to click the I'm not a robot checkbox, above,
before submitting this form.


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