BOXER ASSOCIATION OF VICTORIA Inc.
ABN 24 240 701 423   Incorporation Registration A00 18959H
MEMBERSHIP APPLICATION
ISSUE DATE:  FROM 1ST OCTOBER, 2011 TO 30TH SEPTEMBER, 2012
Fees:
Single Membership
Dual Membership
Aged Pensioner
Junior Membership
Overseas Membership
$40.00 per year
$45.00 per year
$25.00per year (Copy of age pension card required)
$7.00 per year (Available only with an adult membership)
$60.00per year (Above rates apply if bulletin emailed)
*INSURANCE LEVY $6.00 per year (See Below)
*Please note: If you are a Victorian resident and not a member of Dogs Victoria you must add an insurance levy of $6.00 to your membership fees if you participate or intend to participate in any Club activities. This fee must be paid by the Club to Dogs Victoria to cover non Dogs Victoria members for insurance (accidents etc at organized Club activities / functions.)

APPLICANT DETAILS: DOGS VICTORIA Membership NO: .........................
Title: Mr. / Mrs. / Miss / Master / Ms
Name/s: ....................................................................................................................
Postal Address: ....................................................................................................................
..................................................................................................................... Post Code .............
Tel: Home ............................. Mobile:................................... Fax: ......................
Email: ......................................................................................
(Please write email address clearly for receipt of Bulletin and notices)
Residential address if different to Postal address above: ....................................................................................................................................
..........................................................................................


DECLARATION TO BE COMPLETED BY ALL APPLICANTS:
I/WE hereby agree, upon election to any catergory of membership, to strictly act observe and Act in conformity with, and not otherwise than, in accordance with the Act and the Rules and By-Laws of the Club and the Constitution, Rules and Regulations of DOGS VICTORIA Inc . in so far as they shall relate to the members and will uphold the honour of, and endeavour to further the objects of, the Boxer Association of Victoria Inc.  A copy of the Rules and Code of Ethics of the Boxer Association of Victoria Inc is available on request from the Secretary.

Signature of all Applicants .................................................................................................. (If dual membership both parties must sign)

Dated this ............................ day of ................................. 20

Please PRINT this Membership Application and complete in full and return with the appropriate fees to :
The Secretary, Boxer Association of Victoria Inc., PO Box 309, Mount Martha 3934
OFFICE USE ONLY :
The Committee of the Boxer Association of Victoria Inc. accepted / rejected this application at the Committee meeting on the .........................................................
Secretary's signature ............................................... Receipt No. .................................... Membership No.