FCI-IPO, Mondioring or FH Championship Team by bdu12746

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									                 Declaration form: FCI/Mondioring World Championships
                   & FMBB Belgium Shepherd World Championships
Section 1 - Candidate Information
Name of Handler: ___________________________________________________________________________
Address: __________________________________________________________________________________
Contacts: Hm Phone_____________________Wk Phone___________________Mobile___________________
          Fax _________________________ Email_______________________________________________
Name of Owner: ____________________________________________________________________________
Address: __________________________________________________________________________________
Phone: _________________________________Email______________________________________________

Uniform Size (women: indicate both gender and unisex sizes):
Jacket____________________________________________________________________________________
Pants_____________________________________________________________________________________

Section 2 - Dog Information
Dog’s Registered Name: ___________________________________Breed____________________________
Gender: __________ DOB______________ Tattoo________________Tattoo Location__________________
Dog’s Registration Number and Club of Registry: ________________________________________________
Sire’s Name_______________________________________________________________________________
Sire’s Registration No.______________________________________________________________________
Dam’s Name______________________________________________________________________________
Dam’s Registration No.______________________________________________________________________

Section 3 - Other
Is this dog a handler-owner-trained dog? YES ____ NO____ (Owner must have owned the dog from 6 months of age)
Scorebook No.______________________ Club issuing Scorebook: _________________________________
Top two national level scores within the past 12 months: ________________ and______________________
Mondioring candidates see criteria on website (www.usmondioring.org).

NOTE: PLEASE ATTACH A COPY OF THE RELEVANT PAGES OF YOUR SCOREBOOK FOR SCORE VERIFICATION
AND A COPY OF COMPLETE PEDIGREE.

The submittal of this form is a formal declaration candidacy for the AWDF FCI World IPO, Mondioring or FH Championship Team. I am
a member of my AWDF club and in good standing. I realize that withdrawal from the team once the selection process has been finished
could result in unfavorable reviews in subsequent years. I understand I will be responsible for all expenses not covered by the club or
AWDF (check with your club and the AWDF for details).

_______________________________________________                                 _____________________________
Candidate Signature                                                             Date

CANDIDATES: Send this form to your relevant AWDF club; it will be submitted to: Chairperson, AWDF Team Selection Committee by
June 10 (IPO), August 1 (Mondioring) or December 10 (FH). The top two eligible dog-handler teams from the AWDF IPO and FH2
Championships may send the Declaration Form directly to the chairperson. Mondioring dog handler teams will send directly to the MR
chairperson.

AWDF MEMBER (AND GUEST MEMBER) CLUBS: Submit your declared candidates by June 10 (IPO), August 1 (Mondioring) or
December 10 (FH) Be sure to send the copies of the scorebook verifying the scores indicated above and the pedigree. This will greatly
expedite entering information on the entries. Each breed club may send up to 6 nominees for the IPO team and 4 for the FH team. The
Mondioring team can consist of 6 nominees.

For questions, contact: Sharon Novak, 23621 Carona Ave., Corning, CA 96021
E-mail: ysharose@yahoo.com Phone: (530) 824-9100



Declaration Form                                                                                Update: May 2010

								
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