The UK Picardy Spaniel Club
Application for Membership
I/We wish to apply for (FULL/JOINT/FAMILY/OVERSEAS/JUNIOR/NON OWNER- delete as
necessary) membership of the Picardy Spaniel Club and, if elected, I/we understand that such
membership is conditional upon my/our abiding by the Rules of the Club and Code of Ethics
Full Names(s)
(Please print in block capital throughout)
Single: Mr/Mrs/Miss/Ms……………………………………………………………………...........................………………….
Joint: Mr/Mrs/Miss/Ms…………………………………….............................................……………….
Address:………………………………………………………………………………………..………………………………………...
…………………………………………………………………………………………………......…………………................................
Post Code:…………..………...Telephone Number:…………..………..….......Mobile:……….…………..…............
Email address: ………………………………………………………………...........................................
Signed:……………………………………………………………….Date:…………………………………….
The Picardy Spaniel Club is required to make a list of member’s details available for
inspection if so required by the members of the Club or the FCI/Kennel Club. If you
do not want your name to appear on this list please tick the box provided.
If a Picardy Spaniel Owner in the UK: Please include a photocopy of 5 generation pedigree and a
recent photograph of your dog.
Registered Name of Dog:……………………………………...........….
Sex:………......
Date of Birth:………..............................................
FCI Registration Number:…………………………...............
Breeder:…………………………………......................... Breeders’ Affix:………………………...............................
Breeders Address:…………………………………...........................................................................................
Post Code:…………….....................................……..........Country:............................................................
All subscriptions are due on 1st January each year. Payments can be made by cheque, bank transfer
for international members or via standing order. A standing order form is enclosed separately for
this purpose. Please complete the form and return to the secretary so she can allocate a reference
number and send it on to your bank. If you would rather set the order up yourself, electronically,
by telephone or in person, please ask the secretary for your reference number so it can be
included. For this contact please use the contact details given below.
Single Full Membership (Picard Spaniel Owner).......................................…....£10
Joint Full Membership
(Picard Spaniel Owner)…….………....….........................£15
Family Full Membership (Picardy Spaniel Owner).............................................£20
Overseas Membership
(per person)………………………………….............................£10
Junior Membership
(per person)……………..................................................£5
Non Picardy Owner Membership ..........................................................................£5
Overseas members are welcome to pay through their banks using our IBAN and SWIFTBIC as
stated below.
IBAN: GB86TSBS77705800609068
SWIFTBIC: TSBSGB21404
Cheques should be made payable to The UK Picardy Spaniel Club and sent with this form to the
address below:
Miss Natalie Morris, 38 Alderminster, Warwickshire, CV37 8NY
If you require any further information then please use the contact details provided below:
Secretary: Emily Spence
Tel: 01536 761442
Email: contact@picardyspaniel.org.uk
The Picardy Spaniel Club
Standing Order Form
To: The Manager,
Bank
Bank Full Address:
Post Code
Bank Sort Code:
--
--
Account Number:
Account Name:
Please set up the following STANDING ORDER and debit my/our account accordingly.
Pay: The UK Picardy Spaniel Club at TSB Stratford Upon Avon, TSB Bank plc, PO box 1000, BX4 7SB
Sort Code: 77-70-58
Account Number: 00609068
The sum of: ……………... on receipt of this order and thereafter on 1 January ANNUALLY until you are
instructed otherwise.
Signature........................................................... Date …………………………………………
Please return this form to:
Miss Natalie Morris, 38 Alderminster, Warwickshire, CV37 8NY