Official Canadian Kennel Club Entry Form

EPS TRAINING ASSOC.

May 25 and 26, 2013.

ENTRIES OPEN Apr 26/13,
and close May 15/13,
or when limit is reached for each day.

Mail entries to: Ivan Paul,
RR 4, Powassan, Ont., P0H 1Z0.

 
Entry Fee:$_____________    Listing Fee:$___________

[___]TD, Saturday, $75.00 [___]TDX, Saturday, $90.00
[___]UTD, Sunday, $75.00 [___]UTDX, Sunday, $90.00
BREED
REG. NAME OF DOG
Place of Birth    [___] Canada    [___]Elsewhere

Check one and Enter Number here:
[___]CKC Registration Number        
Date of Birth
Is this a puppy?

[___]Yes
[___]No

Sex ____
[___]CKC ERN/PEN Number [___]Day
[___]CKC Misc Cert. [___]Month
[___]Listed [___]Year
Breeder
Sire:
Dam:
Reg'd Owner
Address:
City: Prov: Postal Code
Name of Owners Agent:
Agent's Address:
City: Prov: Postal Code
ID will be emailed to email address at the bottom.        

I Certify that I am the registered owner(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered aboveand accept full responsibility for all statements made in this entry. In consideration of the acceptance of this enty, I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additional rules and rugulations appearing in the premium list.

  Signature of Owner or Agent

                                                      
Email address:
                       
Telephone