Australian Pouter and Cropper Club

Pouter Power

Membership form 

       The Australian Pouter and Cropper Club - Membership Application

I hearby apply for the membership of the Australian Pouter and Cropper Club  my details are as follows

Name: _________________________________________________________________

Address:_______________________________________________________________

Telephone Number: _____________________________                                                      

Mobile Number: _________________________________

Email:_______________________________@_____________________

Date of Birth: (all Juniors must state age):_________/______/______

1) Do you belong to any other pigeon, poultry or caged bird Club? If yes please state club/s: ________________________________________________________________

 _______________________________________________________________________

2)Have you ever been disqualified or refused membership by any club or society? yes/no if yes please state the name of such club:____________________________

 ________________________________________________________________________

3) How did you find out about the Australian Pouter and Cropper Club? optional

 ________________________________________________________________________

4) I am interested in or keep the following breed of pigeon: __________________

 _______________________________________________________________________

 

If my application is successful, i agree to abide by the Rules and Regulations and the by-laws of the Club

Signature: _____________________               Date: _________________________

            

 Please state which membership you are apllying for: _________________

 Membership Rates  are in Australian Dollars

 Family:$20.00

Seniors: $15.00

Pensioners: $10.00

Juniors: $5.00

 Please email or Post all applications to

   Secretary: Ron Kellner

   3 Conway Street

      Toronto West NSW 2283

        Email :  brekel1@bigpond.com