Renewals This renewal form is for existing members only Application for Membership Renewal Member Details Email Title (Mr, Mrs, Miss, Ms, Dr, etc) First Name * Last Name * Address * Suburb * State / Territory * QLDNSWACTVICTASSANTWA Post Code * Phone * Emergency contact name * Emergency contact phone * ADAA Membership Number (if applicable) Facebook Profile Name Please join our private Facebook group "Agility Dog Club of QLD Members". Membership Type * Single - $25/year Family - $25/year Pensioner - $20/year Casual - $5/class Life Member (no payment required) List of Additional Family Members Additional family members must be living at the same address as the primary member. Dates of Class Attendance Dog Details Number of Dogs on Membership * 12340 Currently Dogless 🙁 (Please input "nil" in fields below) Dog #1 Name * Dog #1 Breed * Dog #1 DOB * Dog #1 Sex * Male Female Dog #1 Desexed * Yes No Dog #1 Vaccination Certificate (if not already provided to ADCQ) Drop a file here or click to upload Choose File Maximum file size: 134.22MB ALL DOGS MUST BE IMMUNISED. Minimum requirement is C3 or higher or a titre test. A current copy of the vaccination certificate or titre test renewal must be provided with this form for sighting. DATES WILL BE CHECKED ON JOINING/RENEWAL. Dog #2 Name * Dog #2 Breed * Dog #2 DOB * Dog #2 Sex * Male Female Dog #2 Desexed * Yes No Dog #2 Vaccination Certificate (if not already provided to ADCQ) Drop a file here or click to upload Choose File Maximum file size: 134.22MB ALL DOGS MUST BE IMMUNISED. Minimum requirement is C3 or higher or a titre test. A current copy of the vaccination certificate or titre test renewal must be provided with this form for sighting. DATES WILL BE CHECKED ON JOINING/RENEWAL. Dog #3 Name * Dog #3 Breed * Dog #3 DOB * Dog #3 Sex * Male Female Dog #3 Desexed * Yes No Dog #3 Vaccination Certificate (if not already provided to ADCQ) Drop a file here or click to upload Choose File Maximum file size: 134.22MB ALL DOGS MUST BE IMMUNISED. Minimum requirement is C3 or higher or a titre test. A current copy of the vaccination certificate or titre test renewal must be provided with this form for sighting. DATES WILL BE CHECKED ON JOINING/RENEWAL. Dog #4 Name * Dog #4 Breed * Dog #4 DOB * Dog #4 Sex * Male Female Dog #4 Desexed * Yes No Dog #4 Vaccination Certificate (if not already provided to ADCQ) Drop a file here or click to upload Choose File Maximum file size: 134.22MB ALL DOGS MUST BE IMMUNISED. Minimum requirement is C3 or higher or a titre test. A current copy of the vaccination certificate or titre test renewal must be provided with this form for sighting. DATES WILL BE CHECKED ON JOINING/RENEWAL. Payment Details Payment Method Direct Bank Deposit - Payment Details will be sent in confirmation emailCheque/Money Order - Payable to Agility Dog Club of Queensland Inc. Membership Terms and Conditions I/We hereby apply for membership to the Agility Dog Club of Queensland Inc. (ADCQ). In the event of membership admission, I/We agree to be bound by the Rules and By-Laws of the Club for the time being in force. I/We declare that none of the dogs currently registered in my name with ADCQ are (in full or part) an American Pit Bull Terrier, Japanese Tosa, Argentine Fighting Dog, Brazilian Fighting Dog and/or any other breed which may be deemed as a restricted dog. Nor are any of them individual dogs(s) which have been deemed as dangerous dogs as defined in the Companion Animal Act 1988 (NSW) and/or defined in any other State, Territory or the Commonwealth of Australia equivalent Act. I/We hereby grant permission to ADCQ and its representatives to take photographs or videos of me and to make recordings of my voice at the dog training/competition activities conducted by ADCQ. I further grant to ADCQ and their representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later developed. I acknowledge that ADCQ owns all rights to the images and recordings. I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify and hold harmless ADCQ from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. Acceptance * I accept the above membership terms and conditions. ADCQ COVID-19 Action Plan Please review here (Opens in new tab) * I have read and accept the ADCQ COVID-19 Action Plan If you are human, leave this field blank. Submit Club memberships are due 30 June each year.
