I herewith request membership in the organization
Staffordshire-Hilfe e. V.

______________________________________ _______________________________________
Name first name
   
______________________________________
street  
   
______________________________________ _______________________________________
Zip code/city Country
   
_____________________ _______________________________________
maidenname profession
   
______________________________________ ______________________________________
Telephone Fax
   
eMail-adress: ______________________________________
 
II have _____ Dog(s) _____ Male(s) _____ Female(s)
   
of the race__________________________________
 
I am _____ Owner / _____ Breeder / _____ Admirer of Dogs
   
I am member in an organization of animal sheltering or other organization:
 
______________________________________  
 
The annual fee is minimum € 60,00. When joining during the year, for the remaining months minimum € 5,00. Reduced fee see Club rules § 8.4. The reduced fee is 50 % (proof neccessary). Membership documents will be sent following the first payment
   
I declare that none of the points in § 7 (1 - 4) applies to me.
   
II need a tax certificate: yes / no(please mark)
   
my fee will____________ €
 
______________________________________ ______________________________________
date signature
   

Information for the revers of the membership ID card. This card can be used as emergency pass. You can name the organization to be notified in case of emergency.


Name of member:________________________________________________

 

Notify in case of emergency:__________________________________________


Tel.: ______________________________________________________________

 

Race of dog : ___________________________________________________


Name: _____________________________________________________________


Age or date of birth:______________________________________________


Chip Nr. or Tattoo Nr. ________________________________________________


Special remarks: _____________________________________________________

 

Under special remarks please tell us if the dog needs medication, which, dosis, sequence. How the dog gets along with other animals, etc.

 

Postanschrift: Christine Prochnow * Postfach 41 06 48 * 12116 Berlin