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: