BSDCC 2021 Membership Form

2020 BSDCC membership expires as of January 1st, 2021.

To renew your current membership or apply for membership online and pay by credit card, Paypal, e-transfer, or cheque, please complete the form and submit with your payment.

Note that for credit card/Paypal online payments, a processing fee (2.9% + $0.30) is added to the final cost, this is not an increase of the membership fees.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
example@example.com
Phone Number *

Area Code Phone Number
CKC Membership Number
Family membership *

yes no
Family member #2 Name *

First Name Last Name
Family member #2 email *
example@example.com
Family member #2 phone *

Area Code Phone Number
Family member #2 CKC Membership Number
Variety of Belgian Shepherd owned

Groenendael Laeken Malinois Tervuren
I am a breeder and would like my kennel information listed on the BSDCC website. I understand that this is not an endorsement by the BSDCC it only indicates that my dues are paid and I have signed the membership pledge.

yes no
Kennel name
Website
Type of payment

Credit card Paypal E-transfer Cheque
Please select
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NEW Single Membership $ 57.00 CAD

RENEWAL Single Membership $ 52.00 CAD

NEW Family Membership $ 62.00 CAD

RENEWAL Family Membership $ 57.00 CAD

NEW Junior Membership $ 52.00 CAD

RENEWAL Junior Membership $ 47.00 CAD

NEW Associate Membership $ 52.00 CAD

RENEWAL Associate Membership $ 49.00 CAD

Shipping Newsletter outside of Canada $ 10.00 CAD

Donation Free

Amount

Total $ 0.00 CAD
Membership type

NEW Single ($55) RENEWAL Single ($50) NEW Family ($60) RENEWAL Family ($55) RENEWAL Junior ($45) NEW Junior ($50) RENEWAL Associate ($47) NEW Associate ($52)
Residents of Quebec: some Quebec based banks require a password to be set for e-transfers. In such case please use password "BSDCC" (without quotes, in capital letters).
Donation included for:

National Specialty Rescue Both
Donation amount
For e-transfers, please send to: Treasurer@bsdcc.org
Please specify the name the membership is for on the cheque, and mail it to:

Donna-Marie Cyr
BSDCC Treasurer
705 Jacobson Drive
Williams Lake, BC
V2G 5M2
By signing below and submitting payment the applicant agrees to adhere to the membership pledge:

“As a member of the BSDCC I will observe at all times and under all circumstances, GOOD SPORTSMANSHIP, COURTESY, AND RESPECT FOR OTHER PEOPLE. I will accept and uphold the objects of the Club as set out in the constitution.”
Date

Month Day Year
City and Province
Full Name of Participant *

First Name Last Name
To sign this form on a pc, click/hold in the area below and move to draw your signature.
In case of technical issues, please email webmaster@bsdcc.org
Signature of applicant *

Clear
Signature of applicant *
Signature of applicant
Full Name of applicant #2 *

First Name Last Name
Signature of applicant #2 *

Clear
Signature of applicant #2 *
Should be Empty: