THE AIREDALE ENTHUSIASTS ASSOCIATION
OF QUEENSLAND
Affiliated with the Canine Control Council (Q)

MEMBERSHIP APPLICATION / RENEWAL FORM

Please fill in the following details and return to :

Secretary
R N Grannum
P O Box 71
AMBERLEY, QLD 4306

Single Membership       $15.00     .................
Dual membership       $20.00     ...............
(Please make cheque payable to Airedale Enthusiasts Assoc of Qld)

Date : ...../....../......

Applicants Name : ..............................................................................................

Address : ............................................................................................................

                 ...........................................................................................................

Telephone Number : .....................................................................

Email Address : ..............................................................................

CCCQ or State Canine Conrolling Authority Membership No. ...................................

You do not need to own an Airedale to join the club, but if you do, the following details would be appreciated.

Dog's Call Name : .............................................................................

Registered Name : ............................................................................

Approximate Age : ............................................................................