________________________________________________________
Name of Member (Dues $30.00)
________________________________________________________
Street Address
________________________________________________________
City, State, ZIP Code
________________________________________________________
Telephone Number (with Area Code)
________________________________________________________
E-mail Address (optional)
________________________________________________________
Associate Member(s) (Dues $3.00 each Associate)
Optional donation to Brittany
Rescue (tax deductible) $__________
$_______________________________
Total Amount Enclosed
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Print this form and mail to the address below.
(Please enclose your check payable to the San Diego Brittany Club)
San Diego Brittany Club
Susan Kerns
7360 Florey Street
San Diego, CA 92122-2815
Dues: $30.00 per individual Member plus $3.00 per Associate
Member