Leonberger Association of Victoria Inc.
(A0050833V)


APPLICATION FOR MEMBERSHIP

   I, ..................................................................................... , of ...........................................................................................
                      (Name and Occupation)                                                                        (Address)

   desire to become a member of the Leonberger Association of Victoria Inc. In the event of my admission as
   a member, I agree to be bound by the rules of the Association for the time being in force.

  Telephone:........................................................................................................................................................................

  e-mail:..............................................................................................................................................................................
  (If you have no objection to receiving information via email, please supply your address. This will help the Association
   to keep members informed more and will also save on stationary and postage costs)


  ............................................................................................     ...........................................................................................
                      (Signature of Applicant)                                                                            (Date)



  I, ........................................................................................... , being a member of the Association, nominate the
   applicant, who is personally known to me, for membership of the Association.


  ...........................................................................................     ...........................................................................................
                      (Signature of Nominee)                                                                            (Date)



  I, ........................................................................................... , being a member of the Association, second the
   nomination of the applicant, who is personally known to me, for membership of the Association.

  ...........................................................................................     ............................................................................................
                      (Signature of Seconder)                                                                             (Date)



   FEES
   New members please send your joining fee and subscription to the Secretary, Dayna Lightowler, c/- PO Box 908 Nyora
   Vic 3987.

   Joining Fee ...... $ 5.00

   Membership ......$ 10.00