MEMBERSHIP RENEWAL FORM  
 


Cluck and Quack Poultry Club
2018 MEMBERSHIP
New/Renewal
Individual or family

Send form with $15.00 to :
Kylie Wasiuta
Box 1, Grp 540, RR# 5
Winnipeg,  MB
R2C 2Z2

* Make cheque payable to 'Cluck and Quack Poultry Club'
By becoming a member,
I agree not to use the Membership Directory for any reason
other than personal contact with other members of the Club.

NAME:___________________________________________________________
 
   ADDRESS:________________________________________________________     

                  ________________________________________________________

POSTAL CODE:__________________PHONE NUMBER: __________________

EMAIL ADDRESS:__________________________________________________

Preferred Method of Contact:__________
 (Email ? Snail Mail?)

 

POULTRY AND OTHER CRITTERS OWNED:

BANTAMS:________________________________________________________
STANDARDS:______________________________________________________
      Pheasants_______________________________________________________
__________________________________________________________________
      Ducks__________________________________________________________ 
__________________________________________________________________
     Geese__________________________________________________________
__________________________________________________________________
      Other _feathered-_________________________________________________ 
        _non-feathered-_________________________________________________
     At home Business_________________________________________________
__________________________________________________________________