Single:  1 year $15   2 years $28.50 3 years $40.50
Family: 1 year $20   2 years $ 38.00 3 years $ 54.00
Membership Type? New Renewal
Breeders Directory Yes    No (Must be a club member in good standing for 1 year )  
- Add $20 per year 1 Year 2 Years 3 Years

Membership applications received after November 1st will be applied to the next year's membership.  

Name:

Kennel Name:

Address:

City: Prov: Postal Code:  

Home Phone:   Business Phone:  

Email:

Webpage URL:

May we add your email address to the Ontario Toller Email Group? Yes No

Tollers' Registered Name(s):

Call Name(s):

Are you willing to volunteer to help at local Club sponsored events?   Yes No
How would you like to receive Toll ON!? Print copy (mailed) Electronic (email)

Please send the completed application with a cheque (in Canadian funds) made payable to the Ontario NSDTR club to:  
Dale Dee Dale.Dee@sympatico.ca
833212 4th Line EHS Mono, RR5
Orangeville ON L9W 2Z2

Signature ___________________________________________  Date ___________________________  

CKC Member? Yes    No Member #

Note: When selling a litter of puppies, breeders receive a 10% discount on memberships that are purchased for the puppy buyers.
* Please get your renewal to Dale Dee no later than February 28th to ensure continued voting privileges as well as the ability to advertise in the Breeders Directory.