2017 Membership Form

* Required Fields
Member/s Names

Person 1
Name: *
Person 2
Name:
Child 1
Name:
DOB: (DD/MM/YYYY)
Child 2
Name:
DOB: (DD/MM/YYYY)
Child 3
Name:
DOB: (DD/MM/YYYY)

Main Details

Address: *
Suburb: *
State: *
Post Code: *

Phone Number: *
Mobile:
Email: *
Other Details

Type of Membership: *
How did you find out about the club?:
What breed(s) of dog do you own?:
Do you give permission for photo's of you / your dogs to be used by WASSA / ASSA for promotional material / website? *
ASSA Number: (If a current member)
Payment method: *
Would you like to make a donation to the club?
Do you agree to the terms and conditions below?: *
Terms and Conditions:

Enquiries: committee@wassa.com.au