| The Show-Me Basenji Club |
| Membership Renewal- 2012 |
Member Name _____________________________________________
Co-Member(if any) ______________________________________________
Address
______________________________________________
City ____________________ St. ____ Zip _______________
Phone # (s) ______________________________________________
Email (s) ______________________________________________
Did you register a litter with AKC this year _____ How many ________
Constitution and By-laws and the Code of Ethics may be viewed and printed from
the club website www.showmebasenjiclub.com
-----------------------------------------------------------------------------------------------------------------
I (we) the undersigned are renewing my (our) membership in the Show-Me Basenji
Club. I (we) acknowledge having read the Constitution and Bylaws and Code of
Ethics and will continue to be governed by them to further the objectives of the
club,
Signature _________________________________________ Date ____________
Signature _________________________________________ Date ____________
Membership fee Family $15 and Single $10 Litter Fee $10 per litter
Total Amount being submitted ___________
Send this renewal form along with the appropriate dues to the club Treasurer:
Show-Me Basenji Club
C/O Jan Kahl
236 Northwoods Drive
Pacific, Missouri 63069
(314) 713-5884
Co-Member(if any) ______________________________________________
Address
______________________________________________
City ____________________ St. ____ Zip _______________
Phone # (s) ______________________________________________
Email (s) ______________________________________________
Did you register a litter with AKC this year _____ How many ________
Constitution and By-laws and the Code of Ethics may be viewed and printed from
the club website www.showmebasenjiclub.com
-----------------------------------------------------------------------------------------------------------------
I (we) the undersigned are renewing my (our) membership in the Show-Me Basenji
Club. I (we) acknowledge having read the Constitution and Bylaws and Code of
Ethics and will continue to be governed by them to further the objectives of the
club,
Signature _________________________________________ Date ____________
Signature _________________________________________ Date ____________
Membership fee Family $15 and Single $10 Litter Fee $10 per litter
Total Amount being submitted ___________
Send this renewal form along with the appropriate dues to the club Treasurer:
Show-Me Basenji Club
C/O Jan Kahl
236 Northwoods Drive
Pacific, Missouri 63069
(314) 713-5884
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