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:


B
antam Chickens: ____________________________________________________________________________


____________________________________________________________________________________________


Standard Chickens:____________________________________________________________________________


____________________________________________________________________________________________

 

Pheasants: __________________________________________________________________________________


Ducks: _____________________________________________________________________________________


Geese: _____________________________________________________________________________________
 

Other feathered: ______________________________________________________________________________
 

Non feathered:  _______________________________________________________________________________
 

At home Business: ____________________________________________________________________________