Midwest Boykin Spaniel Retriever Club

Membership Application

 

Date: __________   Email: __________________________

 

Name:  _________________________________________

 

Spouse:_________________________________________

 

Address: _______________________City: ____________

 

State: ____  Zip: _________  Phone: _________________

 

Dog(s) Name

_____________________    ___________________

 

_____________________    ___________________

 

Titles, Interest, hobbies with your Boykin: ______________

 

 

Membership Dues:  $20 - Dues period covers 1st of June to May 30th

 

Amount Enclosed: _______  New Member __  Renewal __

 

Please make payable to:  Midwest Boykin Spaniel Retriever Club and mail to:  Karen Hinchman, 3839 S State Rd 9, Greenfield, IN  46140

 

www.midwestboykinclub.com