The Wirehaired Dachshund Club

Membership Proposal Form

Name ............................................................................................................................................

Address .........................................................................................................................................

.....................................................................................................................................................

Post Code .................................. Tel No .......................................................................................

Proposer................................... Seconder ............................................

I hereby apply for membership of the Wirehaired Dachshund Club and if elected agree to abide by the rules thereof:

Signature ................................................................. Date .................................

In order to comply with the Data Protection Act we hold all members' names and addresses on computer disc.

Please indicate below if you have any objection to us doing so purely for Club use.

Yes .............................................................................. No .......................................................................

_____________________________________________________________________________________________

STANDING ORDER

THIS INSTRUCTION CANCELS ANY PREVIOUS ORDER

To Bank/Building Society ...................................................................................................................................................

Branch ...............................................................................................................................................................................

Address .............................................................................................................................................................................

Name of Account Holder.............................................. Account No to be debited ...............................Sort Code ............

Please pay to the account of the WIREHAIRED DACHSHUND CLUB the sum of £5.00 (Five pounds sterling)

and subsequently on the 1st July each year until cancelled by me in writing.

Signature ................................................................. Date ................................

Account to be credited

THE ROYAL BANK OF SCOTLAND PLC 119/121 VICTORIA STREET, LONDON SW1 6RA

Account Number 71901923 Sort Code 15-30-00

Name .............................................................................................................................................................................

Address ..........................................................................................................................................................................

.................................................................................................................... Post Code...................................................

This form when completed to be returned to the Secretary/Treasurer: