Indy Dog & Disc Club -
Yearly Membership Form
Instructions:
Please print (click
here to print), fill-out, and remit with dues to address below.
Type of
membership: Price:
(Please check one)
__ Individual
with one dog $20.00
__ Individual
with multiple dogs $25.00
__
Family
with one dog
$25.00
__
Family
with multiple dogs
$30.00
Total:
How would you like to receive the
IDDC Newsletter?
Send via email
Send via US mail
Do not send a
newsletter
Handler Info
Name/s:
Address:
Phone: Email:
Dog/s Info
(Please use another sheet if necessary)
Dog’s
Name Breed Rabies
tag # and Exp.
Dog’s Name
Breed Rabies tag # and Exp.
Dog’s
Name Breed Rabies
tag # and Exp.
Dog’s
Name Breed Rabies
tag # and Exp.
Dog’s
Name Breed
Rabies tag # and Exp.
Please make checks payable to:
Indy Dog & Disc Club
Please mail payments to:
S. Galema
930 N Hawthorne Lane
Indianapolis, IN 46219