MPCDC New Members Application Form

After completing and submitting the Mornington Peninsula Community Dog Club New Members Application Form.

Please Note:

– you will be required to show proof of full dog(s) full vaccination & proof of concession (if applicable) as part of the enrollment process.

– you are also required to pay the applicable Membership Fees.

Name *

First

Last

Email *

Phone No *

Address *

Address 2

Town | City *

Postcode *

Membership Type being applied for *

Proof of concession (if applicable) must be provided at time of enrollment

For Family Membership please provide Family Names

First

Last

Age (if under 18)

Additional Family Name 2

First

Last

Age (if under 18)

Additional Family Name 3

First

Last

Age (if under 18)

V.C.A. Membership Number (if applicable)

The Victorian Canine Association Inc (VCA) is a non-VCA member insurance levy that is required to be collected and forwarded to the VCA by all affiliated clubs. This levy applies only to Victorian club members who are not members of the VCA Inc, if you are already a member of VCA let us know and we will adjust the Annual Fee accordingly.

Emergency Contact *

First

Last

Emergency Contact Phone No *

First Dog's Name *

First Dog's Breed *

Sex of First Dog *

First Dog's Date of Birth (DD/MM/YY) - approximate if unknown *

First Dog's Vaccination Due *

Proof of dog vaccination must be provided at the time of enrollment

Second Dog's Name

Second Dog's Breed

Sex of Second Dog

Second Dog's Date of Birth (DD/MM/YY) - approximate if unknown

Second Dog's Vaccination Due

Proof of dog vaccination must be provided at the time of enrollment

MPCDC Club Rules *

I agree to abide by Mornington Peninsula Community Dog Club Rules

I acknowledge at all times I shall be wholly and totally responsible for the care, well-being, health and actions of any dog under my charge at any Club Activity and I declare that the above information provided is true and correct at the time of submiting. By checking this box, I confirm I have read the Club Rules and agree to abide by these rules at all times.