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	National Chinchilla Society
	Application for Membership Single, Joint or Partnership 1st July 2010 to 30th June 2011
	£15.00 Single or Partnership (one voting member). £22.50 Joint membership (two votes, one Gazette). £20.00 Sterling for membership outside UK. A partnership or joint membership is two persons only. ALL APPLICANTS Please fill in the form using BLOCK CAPITALS giving Full Name, Address including Post Code and Telephone Number

MEMBER A Name__________________________ Address________________________ ______________________________ _______________Post Code_______ Telephone No. __________________ E-mail Address__________________ Membership No. (if known)_________ Gazette/Website name___________

MEMBER B Name__________________________ Address________________________ ______________________________ _______________Post Code_______ Telephone No. __________________ E-mail Address__________________ Membership No. (if known)_________ Gazette/Website name___________

ALL APPLICANTS PLEASE ANSWER THE FOLLOWING QUESTIONS:

Tick, delete or complete as necessary

1. To which region do you wish to be affiliated? Scottish ( ), South ( ), West Midlands & Wales ( ), North ( ),
or Scottish ( ). Members outside the UK will automatically be affiliated as International members.
2. May we divulge your Name and Telephone Number to persons requesting assistance in your area? YES/NO
3. Do you intend to show your chinchillas at NCS shows? If yes, list name to appear in NCS Gazette, on NCS Website and on show entry cards (no more than 14 characters – if left blank, surname of Member A will be used – if No is indicated, name will be omitted from NCS results) YES/NO LIST NAME IN BOX ABOVE (surname, ranch name?)

4. Are you a member of, or associated with, any other chinchilla organisation? YES/NO #
5. How were you informed about the NCS? Society Member/Advert/Internet/Other. #
# Please give full details on the reverse of this form where necessary.

Should the elected committee approve your application for membership, you will receive Membership Card(s) for the current year together with a copy of the NCS Constitution and Show Rules. Back issues of Gazettes and Supplements, printed during the current membership period will also be forwarded.

I/We hereby apply for membership of the National Chinchilla Society and agree to be bound by the Constitution and Show Rules of the Society.
Applicant (A) Signature ______________________ Applicant (B) Signature ________________________
Date ______________________ Date ________________________

All cheques to be made payable to the National Chinchilla Society and sent to the Hon. Secretary, National Chinchilla Society, 101 Simmondley Lane, Glossop, Derbyshire. SK13 6LU.

Standing Order

Please pay to the account of the NATIONAL CHINCHILLA SOCIETY. Midland Bank PLC. Cowbridge.

South Glamorgan. SORTCODE 40-18-18. ACCOUNT NUMBER 31529110. the sum of ** Fifteen

pounds (£15) / Twenty-two pounds and fifty pence (£22.50p) / Twenty pounds (£20) immediately

on receipt and then on the 1st July annually thereafter. ** Please delete those that do not apply.

For the Bank. Please quote the reference number when processing. REF No.________ for office use

ACCOUNT NAME ____________________________________ ACCOUNT NO. _________________

NAME OF BANK _____________________________________ SORT CODE. __________________

BANK ADDRESS _________________________________________________________________

______________________________________________________________________________

SIGNATURE _____________________________ DATE ______________

Please send completed order to Hon. Secretary, National Chinchilla Society, 101 Simmondley Lane, Glossop, Derbyshire. SK13 6LU