Belgian d’Uccle & Booted Bantam Club
Membership Application & Information Form
Check one □NEW Member □RENEWAL Member
Dues: $10.00 – 1 year individual membership $25.00 – 3 year individual membership
$7.50 – 1 year Jr. individual membership $20.00 – 3 year Jr. membership
$15.00 – 1 year family membership $35.00 – 3 year family membership
Send this form with check payable to BD & BB Club, c/o 622 Horseshoe LN., Seymour, TN 37865
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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___________________________
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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, and 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:
wegotchikens@charter.net