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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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