Evergreen State American Pit Bull Terrier Club

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					     Evergreen State American Pit Bull Terrier Club

                             ADBSI Sanctioned Conformation Entry Form


Sat ( )
Sun ( )

Paid ________

Arm Band # _______



Registered Name : ____________________________________________________________

ADBA # : _____________________________                       Date of Birth : __________________


Owner / Handler : _____________________________________________________________

Address : ____________________________________________________________________

City, State, Zip : _______________________________________________________________

Phone : ______________________________ Email : _________________________________


                      Male : (   )                                 Female : (   )



4-6 months : (    )                  12-18 months : (    )          3-5 years : (   )

6-9 months : (    )                  18-24 months : (    )          5 years & over : (       )

9-12 months : (       )              2-3 years : (   )              Champions : (        )




          I certify that I am the legal owner or authorized agent of this dog. I personally assume all
responsibilities for this dog an any claims, losses or injuries that may occur regarding this dog. Signing this
form releases the Evergreen State American Pit Bull Terrier Club, its members and officers, the American
Dog Breeders Association, the American Dog Breeders Show Inc and the Evergreen State Fairgrounds fron
any liabilities. Signing this form also acknowledges that you will abide by all ADBSI show rules and failure to
abide by the rules will warrant immediate removal from the show grounds without any refunds.


Signature : __________________________________________________                  Date : _________________

				
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