Membership Application

Fill out online, print, sign and send to the BCD member management.
via mail: BCD-Mitgliederverwaltung Heinz Spütz Am Stickeshof 11 47608 Geldern	via fax: BCD-Mitgliederverwaltung Heinz Spütz Fax: +49 (0)2831-993112

Application for Membership in the BCD

I apply for a membership in the Briard Club Deutschland e.V. as:

		Jahresbeitrag:
	full member	EURO 62,00
	full member without UR (monthly VDH magazin)	EURO 54,00
	student (with written confirmation, up to age 26)	EURO 30,00
	family member *	EURO 15,00
	We will levy an admission fee of	EURO 25,00

Fields with a red star are mandatory!
First Name:	*
Name:	*
Street Address:	*
ZIP code:	*
City:	*
Country:	*
Telephone:	*
Fax:
e-Mail:
Family member of *
Date of birth:	*
I own a dog:	JA NEIN
Name of the dog:
Breeder of the dog:

Direct debit authorization:
Account number:
Bank code:
Name of Bank

City, Date

___________________________________

Signature

___________________________________