St. Croix Valley Brittany Club
"Dedicated to Improving the Breed"
www.scvbc.org

Membership Application Request Form

Name: __________________________________ Phone: __________________________

Address: __________________________________ E-Mail: _________________________

City: __________________________________ State: _____ Zip Code: __________

Dog's Name: __________________________________ Breed: __________________________

Dog's Name: __________________________________ Breed: __________________________

Dog's Name: __________________________________ Breed: __________________________


I am interested in the following club events
[ ] Annual Banquet [ ] Winter Hunt [ ] Fun Run [ ] AKC Field Trials [ ] AKC Hunt Tests [ ] American Field Trials [ ] Game Fair [ ] Training Sessions [ ] Other __________________
Membership Type (check one)
[ ] I am enclosing $30.00 dues for a "Full" membership, which includes a subscription to the American Brittany magazine. [ ] I am enclosing $15.00 dues for an "Associate" membership, which does NOT include a subscription to the American Brittany magazine. [ ] I am enclosing $5.00 dues for an additional family member.

Print this page out and mail to:
St. Croix Valley Brittany Club, 8764 Norwood Lane, Maple Grove, MN 55369