ELIGIBILITY
Document Sample
Notice to Exhibitors
SAFETY, BEHAVIOR, LIABILITY: Members of the New Mexico Herding Dog Association (NMHDA) and Free
To Be Ranch and their agents, assume no responsibility for any loss, damage, or injury sustained by NEW MEXICO HERDING DOG ASSOCIATION
exhibitors, handlers, or their dogs, or property, and further assume no responsibility for injury to children
PREMIUM – ALL BREED AKC HERDING TEST AND TRIALS
or guests.
FRIDAY, July 3, 2009
NMHDA may decline any entries for cause and may refuse to receive or may remove any dog on account of SATURDAY, July 4, 2009
disease, viciousness or other cause and no one shall have any claim or recourse against NMHDA, Free
To Be Ranch, nor any official thereof. SUNDAY, July 5, 2009
Safety of the dogs is our primary concern. By entering this event, exhibitors acknowledge that they are Licensed by the American Kennel Club
familiar with the rules and regulations of the sport. AKC EVENT #:
Friday Course A Sheep/Test 2009225301; Friday Course A Ducks/Course B Sheep 2009225305;
All dogs must be on a leash at all times except when on course. It is expressly understood that the Saturday Course A Sheep/Test 2009225306; Saturday Course A Ducks/Course B Sheep 2009225302;
exhibitors alone are responsible for the behavior of their dogs, guests and/or children. Those engaging in Sunday Course A Sheep/Test 2009225303; Sunday Course A Ducks/Course B Sheep 2009225304
unsafe or disruptive behavior may, at the discretion to the Trial Committee, be asked to leave the site. In Certification
such cases, there will be no refund of fees paid. In consideration of others, you will be expected to clean Permission has been granted by the American Kennel Club for the holding of these events under American
up after yourself and your dogs at the event site and at your motel. Failure to do so may be cause for Kennel Club Rules and Regulations
dismissal. James P. Crowley, Secretary
Refunds: Entry fees will not be refunded in the event that a dog is absent, disqualified, excused, or barred
from competition by action of the Trial Committee. No entry fees will be refunded if the event can not
OPENING DATE FOR ENTRIES: April 15, 2009
open or be completed by reason of riots, civil disturbances, fire, violent acts of nature, public emergency, CLOSING DATE FOR ENTRIES: June 3, 2009 5 pm MST
or any other cause beyond the control of the Trial Committee. All rules and regulations governing the use
of the Free To Be Ranch facility and all regulations and decisions of the Trial Committee will be strictly ENTRY FEES: $45 for Sheep, $40 Ducks and Testing per dog
enforced, including and not limited to the recording information of this premium list.
CLASSES OFFERED: A and B Course Sheep and A Course Ducks/Testing
Faxed, telephoned, unsigned, or incomplete entries cannot be accepted. Entries submitted that are not on
the provided official AKC entry forms provided in this premium (or reasonably recognized and accepted METHOD OF ENTRY: First Received, Total of 50 runs per day per individual trial.
AKC similar forms) will not be accepted. All AKC entry forms shall contain the agreement and rules as part
of the entry form. No entry shall be made and no entry shall be accepted which specifies any conditions to
These events will be held outdoors regardless of weather.
its acceptance.
Open to all AKC Recognized Herding Breeds and Foundation Stock Service Breeds listed on the AKC website.
Dogs with PAL/ILP#s, nine month of age or older may enter Trials and Tests.
Multiple entries per single envelope will be accepted. Multiple entries could include a combination of one
dog entered in the six trials, or multiple doges entered in any combination of the six trials.
Returned checks do not constitute a valid entry fee and are subject to an added collection fee as
Send entries to: NMHDA, Arlene Starkey, Trial Secretary, 211 Summer
determined appropriate by the NMHDA bank of record, Bank of the West. Winds Dr NE, Rio Rancho, NM 87124. Make checks payable to NMHDA.
Changes and corrections to the entry forms must be received in writing prior to the close of entries. Email
notification is considered acceptable, telephone notification is not considered acceptable.
TRIAL WILL BE HELD AT:
Entries cannot be accepted, cancelled, altered, or substituted after the entries have closed, except as
provide for in Chapter 11, Section 6 of the Rules Applying to Dog Shows. Owners are responsible for errors
in the entry form, regardless of who may make such errors.
Free To Be Ranch
#54 CR BO 46
Mountainair, NM 87036
2009 OFFICERS OF THE NMHDA: MOTEL ACCOMODATIONS:
President: Geri Abrams Comfort Inn: 119 Route 66 East, Moriarty, NM - (505) 832-6666
Vice President: Karen Lightfoot Days Inn: PO Box 367, 1809 West Rte. 66, Moriarty, NM - (505) 832-4451
Secretary: Sandra Kieft Econo Lodge: 1316 Route 66 West, Moriarty, NM, 505-832-4457
Treasurer: Arlene Starkey Holiday Inn Express: 1507 Route 66, Moriarty, NM - (505) 832-5000
Board of Directors: Kathie Woods Super 8: PO Box 1127, 1611 West Old Route 66, Moriarty, NM - (505) 832-6730
Turner Inn and RV Park: 303 E Highway 60, Mountainair, NM 87036, 1-888-847-0170
Casa Monzano Bed & Breakfast: Tajique, NM 87016, 505-384-9767
TRIAL COMMITTEE:
Trial Chairman: Geri Abrams at freetoberanch@aol.com
Moriarty is about 45 minutes away and Mountainair is about 10 minutes away from trial site.
AKC Trial Secretary and Contact: Arlene Starkey, 505-892-8538 or arlene.starkey@att.net
Associate Trial Secretary: Heather Mann
Committee Members: Kathie Woods, Geri Abrams, Sandra Kieft, Leon Harrison, There will be FREE sandwiches and snacks provided at the site for owners and handlers. Other guests at
Arlene Starkey, Karen Lightfoot the trials may join us, but please contribute $5 for the on-site service.
VETERINARIAN (ON CALL) RV HOOKUPS - ELECTRIC AND WATER AT FREE TO BE RANCH
Valencia Animal Clinic By reservation only - 30 amp charge is $20 per night - 50 amp charge is $25 per night
1533 East River Road - Belen, New Mexico 87002 - 505-864-4075
Send your request for a RV Hookup with your trial entry. Include a separate check made out to Free To Be
AVMA STATEMENT Ranch for $25 as a deposit. Deposit is not refundable after entry close date, June 3, 2009.
Exhibitors should follow their veterinarian’s recommendations to assure their dogs are free of internal and
external parasites, any communicable diseases and have appropriate vaccinations. You should always have DRY CAMPING AT FREE TO BE RANCH - DOES NOT INCLUDE ANY SERVICES
a copy of your dog’s Rabies vaccination certificate with you when you travel. Parking spots will be assigned based on availability. Water may be purchased for $5.00 a fill up.
JUDGES: NO DUMPING OF RV TANKS IS ALLOWED ON RANCH PROPERTY DUE TO ENVIRONMENTAL
Event Number Judge Address CONCERNS. There is a public dumping facility at the Turner Inn and RV Park in Mountainair.
Friday, July 3, 2009 2009225301 Susan Abrams 16300 W Simmons Rd
Edmond, OK 73003-9497
EMERGENCY/DISASTER PROCEDURES:
Friday, July 3, 2009 2009225305 Bonnie A Daley 5543 McKenzie Woolard Road
Our emergency coordinator will be on the grounds throughout the trial. A list of emergency
Deer Park, WA 99006
Saturday, July 4, 2009 2009225306 Sandra Lindenmuth 316 Glenn Rd contacts will be posted and the coordinator will assist you in reaching whatever assistance is
Franklin, GA 30217-6040 needed.
Saturday, July 4, 2009 2009225302 Susan Abrams 16300 W Simmons Rd
Edmond, OK 73003-9497 FIRE/AMBULANCE/POLICE
Sunday, July 5, 2009 2009225303 Bonnie A Daley 5543 McKenzie Woolard Road Torrance County
Deer Park, WA 99006 911
Sunday, July 5, 2009 2009225304 Sandra Lindenmuth 316 Glenn Rd
Franklin, GA 30217-6040
DIRECTIONS TO TRIAL SITE
RIBBON AND ROSETTE PRIZES DIRECTIONS FROM INTERSTATE 40 IN NEW MEXICO: Take Exit 196 in Moriarity, go south on
Trial: Hwy 41 until it dead ends into Hwy 60,Take a right (west) onto Hwy 60, go approximately 7 miles on Hwy 60 1/2
mile past mile marker 209 to County Road BO 46, Turn right (North) onto County Road BO 46. Follow the signs.
Qualifying Score ……….. Dark Green strip ribbon DIRECTIONS FROM INTERSTATE 25 IN NEW MEXICO: Take Exit 175 in Bernardo, go east on Hwy
First Place ……….. Blue strip ribbon 60, Go thru blinking light in the town of Mountainair, On Hwy 60 go 1/2 mile past mile marker 208 to County Road
BO 46, Turn left (North) onto County Road BO 46. Follow the signs.
Second Place ……….. Red strip ribbon
Third Place ……….. Yellow strip ribbon
Fourth Place ……….. White strip ribbon LIVESTOCK
Fifth Place ……….. Pink strip ribbon Sheep will be Dorper and Dorper crosses. Ducks will probably be Call Ducks. Handlers will be
High In Trial ……….. Blue, Red and Yellow Rosette responsible for injured or killed livestock. Replacement cost: Sheep: $200.00, Duck: $50.00
Reserve High In Trial ……….. Red, Yellow and White Rosette
Test:
Qualifying Score ……….. Dark Green strip ribbon
ELIGIBILITY OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM
All dogs nine months of age or older that are registered with the American Kennel Club and classified as Herding Dogs NEW MEXICO HERDING DOG ASSOCIATION
under Chapter 2 of the Dog Show Rules are eligible to participate in herding tests and trials. Dogs classified as Herding AKC LICENSED HERDING TESTS AND TRIALS
Dogs under Chapter 2 of the Dog Show Rules that have been granted an Indefinite Listing Privilege (ILP) may EVENT # s: 20099225301, 20099225305, 20099225306, 20099225302, 20099225303, 20099225304
participate in tests and trials. Free To Be Ranch, #54 CR BO 46, Mountainair, NM 87036
July 3, 4, 5, 2009
No dog may be entered in two classes on the same course with the same kind of stock under the same judge at any
Entry fees: $45.00 per dog for each trial entry sheep or ducks; $40.00 per dog for each test entry
test/trial.
Entries close at Trial Chairman’s Office at 5:00 PM MT June 3, 2009 or when limit is reached after which time entries
Bitches in season shall be eligible and will run at the end of the class in tests, and in catalog order as listed in the class cannot be accepted, canceled, or substituted, except as provided for in Chapter 3 Section I of the Regulations for
in trials. Herding Tests and Trials.
A dog must be entered in the name of the person who actually owned it at the time entries for the herding test or trial Event Limit: 50 runs per day (combined) per trial; Duck runs limited by stock available.
closed. If a registered dog has been acquired by a new owner, it must be entered in the name of its new owner in any Checks payable in U.S. funds to: NMHDA
herding test or Trial for which entries closed after the date of acquisition, regardless of whether the new owner has Send to: Arlene Starkey, Trial Secretary, 211 Summer Winds Dr NE, Rio Rancho, NM 87124
received the registration certificate indicating that the dog is recorded in his or her name. State on entry form whether
transfer application has been mailed to AKC. (for complete rule refer to Chap. 14, Sect 3 of "Rules Applying to Do not send entries by any method which requires signature for delivery.
Registration and Dog Shows")
Friday, July 3, 2009 Saturday, July 4, 2009 Sunday, July 5, 2009
AGREEMENT
20099225301 20099225305 20099225306 20099225302 20099225303 20099225304
I (we) acknowledge that the "Rules Applying to Registration and Dog Shows" and the "Rules for Herding Tests and
Trials" have been made available to me (us) and that I (we) agree that the club holding this Herding Test or Trial has the Course Tests Course Course Course Tests Course Course Course Tests Course Course
right to refuse this entry for cause which the club shall deem to be sufficient. In consideration of the acceptance of this A B A A B A A B A
entry and of the holding of the Herding Test or Trial and of the opportunity to have the dog tested or judged and to win Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks
prize money, ribbons, or trophies, I (we) agree to hold this club, its' members, directors, governors, officers, agents, __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std
superintendents or show secretary and owner or lessor of the premises and any employees of the aforementioned __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int
parties harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv
person or thing by the act of this dog while in or upon the Herding Test or Trial premises or grounds or near any
entrance thereto, and I(we) personally assume all responsibility and liability for any such claim for damage or injury to Breed: Variety Sex: Date of Birth:
the dog, whether such loss, disappearance, theft, damage or injury be caused or alleged to be caused by the negligence
of the club or any of the parties aforementioned, or by the negligence of any other person, or any other causes. REGISTERED NAMEOF DOG (AKC titles only):
I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless
from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the Registration No: Call Name:
aforementioned parties for damage because of bodily injuries, including death at any time resulting there from,
sustained by any person or persons, including myself (ourselves) or on account of damage to property, arising out of or ___AKC # ___ AKC Litter # ___PAL/ILP # ___FSS# ___Foreign Reg. #. & Country
in consequence of my (our) participation in the Herding Test or Trial, howsoever such injuries, death or damage to Breeder:
property may be caused, and whether or not the same may have been caused or may be alleged to have been caused
by negligence of the aforementioned parties or any of their employees or agents, or any other persons. Sire:
I (we) will pay for any livestock injuries or replacement value in the event of death of any livestock by my (our) dog. In
case of any injury to any stock caused by the dog entered, I (we) will assume total responsibility for any damage I (we) Dam:
agree to pay the full market value of the injured animal in case of serious injury, or the veterinarian bill if the injury is
slight. Actual Owner(s) : PLEASE PRINT or TYPE
I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO
THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND MYSELF (OURSELVES)
Address:, City, State, Zip
OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED
BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITARATION
Name of owner’s agent (if any): Fee enclosed:
ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS
AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS,
RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I
have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the Rules and Regulations of
the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations
Single copies of the latest editions of the "Rules Applying to Registration and Dog Shows" and the "Regulations for
appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by the "Agreement"
Herding Tests and Trials" may be obtained WITHOUT CHARGE from the AMERICAN KENNEL CLUB, 51 MADISON
printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or
AVENUE, NEW YORK, NEW YORK 10010
other dogs. This entry is submitted for acceptance on the foregoing representation and agreement.
SIGNATURE of owner or agent duly authorized to make this entry
Signature ____________________________________________________________________ Date: ___________________________________________
PHONE: *E-MAIL:
*Entry confirmations and judging programs will be sent via e-mail.
OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM
NEW MEXICO HERDING DOG ASSOCIATION NEW MEXICO HERDING DOG ASSOCIATION
AKC LICENSED HERDING TESTS AND TRIALS AKC LICENSED HERDING TESTS AND TRIALS
EVENT # s: 20099225301, 20099225305, 20099225306, 20099225302, 20099225303, 20099225304 EVENT # s: 20099225301, 20099225305, 20099225306, 20099225302, 20099225303, 20099225304
Free To Be Ranch, #54 CR BO 46, Mountainair, NM 87036 Free To Be Ranch, #54 CR BO 46, Mountainair, NM 87036
July 3, 4, 5, 2009 July 3, 4, 5, 2009
Entry fees: $45.00 per dog for each trial entry, sheep or ducks; $40.00 per dog for each test entry Entry fees: $45.00 per dog for each trial entry sheep or ducks; $40.00 per dog for each test entry
Entries close at Trial Chairman’s Office at 5:00 PM MT June 3, 2009 or when limit is reached after which time entries Entries close at Trial Chairman’s Office at 5:00 PM MT June 3, 2009 or when limit is reached after which time entries
cannot be accepted, canceled, or substituted, except as provided for in Chapter 3 Section I of the Regulations for cannot be accepted, canceled, or substituted, except as provided for in Chapter 3 Section I of the Regulations for
Herding Tests and Trials. Herding Tests and Trials.
Event Limit: 50 runs per day (combined) per trial; Duck runs limited by stock available. Event Limit: 50 runs per day (combined) per trial; Duck runs limited by stock available.
Checks payable in U.S. funds to: NMHDA Checks payable in U.S. funds to: NMHDA
Send to: Arlene Starkey, Trial Secretary, 211 Summer Winds Dr NE, Rio Rancho, NM 87124 Send to: Arlene Starkey, Trial Secretary, 211 Summer Winds Dr NE, Rio Rancho, NM 87124
Do not send entries by any method which requires signature for delivery. Do not send entries by any method which requires signature for delivery.
Friday, July 3, 2009 Saturday, July 4, 2009 Sunday, July 5, 2009 Friday, July 3, 2009 Saturday, July 4, 2009 Sunday, July 5, 2009
20099225301 20099225305 20099225306 20099225302 20099225303 20099225304 20099225301 20099225305 20099225306 20099225302 20099225303 20099225304
Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course
A B A A B A A B A A B A A B A A B A
Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks
__Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std
__Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int
__Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv
Breed: Variety Sex: Date of Birth: Breed: Variety Sex: Date of Birth:
REGISTERED NAMEOF DOG (AKC titles only): REGISTERED NAMEOF DOG (AKC titles only):
Registration No: Call Name: Registration No: Call Name:
___AKC # ___ AKC Litter # ___PAL/ILP # ___FSS# ___Foreign Reg. #. & Country ___AKC # ___ AKC Litter # ___PAL/ILP # ___FSS# ___Foreign Reg. #. & Country
Breeder: Breeder:
Sire: Sire:
Dam: Dam:
Actual Owner(s) : PLEASE PRINT or TYPE Actual Owner(s) : PLEASE PRINT or TYPE
Address:, City, State, Zip Address:, City, State, Zip
Name of owner’s agent (if any): Fee enclosed: Name of owner’s agent (if any): Fee enclosed:
I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I
have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the Rules and Regulations of have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the Rules and Regulations of
the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations
appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by the "Agreement" appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by the "Agreement"
printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or
other dogs. This entry is submitted for acceptance on the foregoing representation and agreement. other dogs. This entry is submitted for acceptance on the foregoing representation and agreement.
SIGNATURE of owner or agent duly authorized to make this entry SIGNATURE of owner or agent duly authorized to make this entry
PHONE: *E-MAIL: PHONE: *E-MAIL:
*Entry confirmations and judging programs will be sent via e-mail. *Entry confirmations and judging programs will be sent via e-mail.
OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM
NEW MEXICO HERDING DOG ASSOCIATION NEW MEXICO HERDING DOG ASSOCIATION
AKC LICENSED HERDING TESTS AND TRIALS AKC LICENSED HERDING TESTS AND TRIALS
EVENT # s: 20099225301, 20099225305, 20099225306, 20099225302, 20099225303, 20099225304 EVENT # s: 20099225301, 20099225305, 20099225306, 20099225302, 20099225303, 20099225304
Free To Be Ranch, #54 CR BO 46, Mountainair, NM 87036 Free To Be Ranch, #54 CR BO 46, Mountainair, NM 87036
July 3, 4, 5, 2009 July 3, 4, 5, 2009
Entry fees: $45.00 per dog for each trial entry, sheep or ducks; $45.00 per dog for each test entry Entry fees: $45.00 per dog for each trial entry, sheep or ducks; $45.00 per dog for each test entry
Entries close at Trial Chairman’s Office at 5:00 PM MT June 3, 2009 or when limit is reached after which time entries Entries close at Trial Chairman’s Office at 5:00 PM MT June 3, 2009 or when limit is reached after which time entries
cannot be accepted, canceled, or substituted, except as provided for in Chapter 3 Section I of the Regulations for cannot be accepted, canceled, or substituted, except as provided for in Chapter 3 Section I of the Regulations for
Herding Tests and Trials. Herding Tests and Trials.
Event Limit: 50 runs per day (combined) per trial; Duck runs limited by stock available. Event Limit: 50 runs per day (combined) per trial; Duck runs limited by stock available.
Checks payable in U.S. funds to: NMHDA Checks payable in U.S. funds to: NMHDA
Send to: Arlene Starkey, Trial Secretary, 211 Summer Winds Dr NE, Rio Rancho, NM 87124 Send to: Arlene Starkey, Trial Secretary, 211 Summer Winds Dr NE, Rio Rancho, NM 87124
Do not send entries by any method which requires signature for delivery. Do not send entries by any method which requires signature for delivery.
Friday, July 3, 2009 Saturday, July 4, 2009 Sunday, July 5, 2009 Friday, July 3, 2009 Saturday, July 4, 2009 Sunday, July 5, 2009
20099225301 20099225305 20099225306 20099225302 20099225303 20099225304 20099225301 20099225305 20099225306 20099225302 20099225303 20099225304
Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course Course Tests Course Course
A B A A B A A B A A B A A B A A B A
Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks Sheep Sheep Ducks
__Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std __Std __HT __Std __Std
__Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int __Int __PT __Int __Int
__Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv __Adv
Breed: Variety Sex: Date of Birth: Breed: Variety Sex: Date of Birth:
REGISTERED NAMEOF DOG (AKC titles only): REGISTERED NAMEOF DOG (AKC titles only):
Registration No: Call Name: Registration No: Call Name:
___AKC # ___ AKC Litter # ___PAL/ILP # ___FSS# ___Foreign Reg. #. & Country ___AKC # ___ AKC Litter # ___PAL/ILP # ___FSS# ___Foreign Reg. #. & Country
Breeder: Breeder:
Sire: Sire:
Dam: Dam:
Actual Owner(s) : PLEASE PRINT or TYPE Actual Owner(s) : PLEASE PRINT or TYPE
Address:, City, State, Zip Address:, City, State, Zip
Name of owner’s agent (if any): Fee enclosed: Name of owner’s agent (if any): Fee enclosed:
I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I
have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the Rules and Regulations of have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the Rules and Regulations of
the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations
appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by the "Agreement" appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by the "Agreement"
printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or
other dogs. This entry is submitted for acceptance on the foregoing representation and agreement. other dogs. This entry is submitted for acceptance on the foregoing representation and agreement.
SIGNATURE of owner or agent duly authorized to make this entry SIGNATURE of owner or agent duly authorized to make this entry
PHONE: *E-MAIL: PHONE: *E-MAIL:
*Entry confirmations and judging programs will be sent via e-mail. *Entry confirmations and judging programs will be sent via e-mail.
