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:__________________________________________________

 

POULTRY AND OTHER CRITTERS OWNED:

Bantam Chickens:________________________________________________________
______________________________________________________________________
Standard Chickens:_______________________________________________________
______________________________________________________________________
      Pheasants_________________________________________________________________
      Ducks___________________________________________________________________
     Geese___________________________________________________________________
      Other feathered ____________________________________________________________
        Non feathered _____________________________________________________________
     At home Business__________________________________________________________