Membership Application Form

For Office Use Only: Membership Number: C/B Date: Receipt Number:

Dear Sir/Madam, Please enrol me as an Ordinary / Life member of the Labrador Retriever Club of India, Karnataka Chapter. I am enclosing a cheque/demand draft/cash for INR . I declare that I own a Labrador Retriever registered with The Kennel Club of India, and the details of which are given below. I agree to abide by the Bylaws, rules and regulations of the club. Date: Name: Address & Phone Number: Patron : INR 1,00,000/Life Member Fee : INR 5,000/Ordinary Member : INR 2,000/Annual Subscription 500/(for ordinary members) (one time Fee)

: INR

Proposed By: Seconded By:

Paste member photograph here

Details of Dogs Owned: Registered Name of Dog 1. 2. 3. 4.

NB: Money order/Cheque/Demand Draft (payable in Bangalore) to: The Labrador Retriever Club of India, (Karnataka Chapter).
** All applications should be accomapnied by a recent passport size photograh, address proof and KCI registration certificate of ownership

KCI Registration Number

1326, 27th Main, 27th Cross, Banashankari 2nd Stage, Bangalore 560070, Karnataka, India Ph: +91-80-26714875,