MEMBERSHIP APPLICATION - $75.00 Individual Membership $100.00 Family Membership

Member Profile – please print clearly

Date:           __________________  email:          ______________________________________

First Name:  ________________________   Last Name:  ________________________________

Address:      ________________________________________________________

City:   ______________________Province:________Postal Code:___________

Phone type   (Home /cell)     Phone #:     __________________________

CKC #:        ___________________ NFA Insurance required   Y or N

Optional Member Profile Information - not shared in distribution list

Family or significant other: ____________________________________________________

*All information is held in strictest confidence with the Treasurer and Secretary of the Calgary English

Springer Spaniel Club for a Master list of our current members. New members will be provided a

membership list upon their completion of this membership profile.

As a member you agree to have your name, email, phone number, and club position distributed to club

members only.  The purpose of this list is: knowing members of the club and the ability to contact

individuals for events & training opportunities held by the Calgary English Springer Club.  By completing

this form, you agree that the list that you will be provided will not be shared with individuals outside

the club members.

Signature: ____________________________________

Please email to Club Secretary = soon to be published