International Birddog Association

Membership Application

Date  ______________

The purpose of this form is to compile detailed membership files.  Feel free to supplement the information on this form with any data you feel might be useful to the International Birddod Association.  Please complete and mail, with your check made payable to the IBDA.

Mail the check to:  Suxanne Cobb, 1845 Port Stanhope Place, Newport Beach, CA 92660

Name ____________________________________________          Home Tel No. ________________

Spouse Name _____________________________________           Cell Phone  __________________

Address  ____________________________________   City State Zip _________________________

Country _____________________________  email ________________________________________

Dues Structure  Circle the date and amount that applies for the month of your Application

Jan - Apr  $30.00          May - Aug  $20.00          Sep - Dec  $10.00

(Membership dues includes Web Site Access and Bark)

Membership Information

Do you own a Birddog  Yes___  No___  Model No _________  Serial No __________

Comments __________________________________________________________________


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