Name:       __________________________________ Phone: __________________________ 

Address:    __________________________________ E-Mail: _________________________ 

City:       __________________________________ State: _____ Zip Code: __________

Dog's Name: __________________________________ Breed: __________________________

Dog's Name: __________________________________ Breed: __________________________

Dog's Name: __________________________________ Breed: __________________________


I am interested in the following club events

[ ] Field Trials [ ] Specialty Shows [ ] Hunt Tests [ ] Other ________________


Membership Type (check one)
[ ] I am enclosing dues of $30.00 for a "Full" membership, which
    includes a subscription to the American Brittany magazine.

[ ] I am enclosing dues of $15.00 for an "Associate" membership,
    which does NOT include a subscription to the American Brittany magazine.


Print this page out and mail to:
Iowa Brittany Club, 1758 295TH STREET, ARGYLE, IA 52619