Belgian d’Uccle & Booted Bantam Club

Membership Application & Information Form

 NEW Membership  RENEWAL Membership

Dues: $10.00 – 1 year individual membership $7.50 – 1 year Jr. individual membership

          $25.00 – 3 year individual membership $20.00 – 3 year Jr. membership

         $15.00 – 1 year family membership       $35.00 – 3 year family membership

www.belgianduccle.org

Send this form with check payable to BD & BB Club, c/o 3490 Pruss Hill Road, Pottstown, PA 19464

     YES I want my name and contact information posted on the members section of the club web page.

     NO I do not want my name and contact information posted on the members section of the club web page.

NAME (LIST ADULT’S & CHILDREN’S NAMES & AGES FOR FAMILY MEMBERSHIPS) _______________________________________

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ADDRESS ___________________________________________________________________________________

CITY___________________________________________ STATE______ ZIP__________-- ________________

PHONE (WITH AREA CODE) _________________________________________________________________________

TODAY’S DATE___________________________ *EMAIL__________________________________________

LIST THE BREEDS AND VARIETIES YOU RAISE:________________________________________________________________________________

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We’re glad to have you!

Your membership includes our club newsletter. In order to save costs, the newsletter will be emailed

whenever possible. *Don’t forget to include your email address.

And please feel free to submit something for our newsletter. Write an article, list what you have for

sale, share some tips, review a show you went to, tell us about your birds or your wins, send a digital

photo. . . Juniors welcome to submit too.

Let’s hear what you’re up to! Snail mail to the above address or email your stuff to:

nniggel@verizon.net