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Fill out completely, print and mail to the EJRTCA.
NAME: _____________________________________________________________________________
ADDRESS: __________________________________________________________________________
CITY: _____________________ STATE: ____________ ZIP: __________________________________
COUNTRY: __________________________________________________________________________
Telephone/Fax/Internet Information
HOME PHONE: ______________________________________________________________________
CELL PHONE: _______________________________________________________________________
BUSINESS PHONE: ___________________________________________________________________
FAX NUMBER: _______________________________________________________________________
EMAIL ADDRESS: ____________________________________________________________________
WEBSITE NAME: _____________________________________________________________________
WEBSITE ADDRESS: __________________________________________________________________
Type of Membership Requested.....Make Checks payable to EJRTCA
NEW: $20.00 (yearly)
RENEWAL: $20.00 (yearly)
ADDRESS CHANGE: $10.00
BREEDER REFERRAL: $25.00 (yearly)
Please check: Payment enclosed ( ) Payment submitted On Line ( )
What Information do you need?
EJRTCA......Construction & By Laws ( )
EJRTCA......Breeder Registration Form ( )
I hereby apply for membership in the English Jack Russell Terrier Club Alliance Inc. and agree to abide by the
objectives and purposes stated in the EJRTCA Constitution and By Laws.
Sign: _________________________________________ Date: _____________________________
Form ej-membership.html Issued 4/8/97 updated 9/8/99, 7/6/05. 1/01/07
© English Jack Russell Terrier Club Alliance, Inc.
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