Podium Belgian Shepherd Working Dog Club

Trial Entry Form

June 01 – 03, 2007

 

 

Trial Entry     [ ] BH   $50      [ ] TR 1   $50          [ ] TR 2   $50          [ ] TR 3   $50          [ ] OB 1   $50          [ ] OB 2   $50         

[ ] OB 3   $50         

[ ] SchH 1   $75         [ ] SchH 2   $75         [ ] SchH 3   $75         [ ] FH 1   $75           [ ] FH 2   $75            [ ] IPO 1   $75          

[ ] IPO 2   $75            [ ] IPO 3   $75        

    

 

Owner’s Name

 _______________________________________________________________________

Owner’s Address

 _______________________________________________________________________ 

City  ____________________________ State __________  Zip ___________________

 

Owner’s Phone (_____)_______-_______    Other Phone (_____)_______-_______

Owner’s E-Mail

 ________________________________________________________________________

AWMA Member Number ______________ Other Member Number ____________

Club Name

 ____________________________________________________________________________

 

 

 

 

 

Handler Name

_________________________________________________________

Handler Address 

 _______________________________________________________

 

City  ______________________ State ______   Zip _____________

 

Owner’s Phone (_____)_______-_______   

Other Phone (_____)_______-______________

Handler E-Mail ________________________________________________________

AWMA Member Number _____________

Other Member Number _______________

Club Name ____________________________________________________________

 

 
   

 


 

 

 

Please make checks or money orders payable to:  Podium Club. 

Payment MUST accompany entries. 

 

Send Entries to:

Mrs. Sabine Ernsting

137 Egypt Rd.

Kearneysville, WV 25430

 

 

Release Statement

 

It is understood that every dog at this event will at all times be in the care and control of the dog's handler.  It is further understood that the undersigned agrees to be fully responsible for the actions of that dog, while on the show grounds.  I agree to hold the Podium Belgian Shepherd Working Dog Club, the American Kennel Club AKC), and the American Working Malinois Association (AWMA), as well as their members, officers, directors, and all property owners harmless for loss or injury which may have been caused directly or indirectly to any person or thing by any act of my dog(s) while on the show premises.  I hereby assume all responsibility and liability for such claims.

 

 

 

Owner, Handler or Agent __________________________________________  Date_______________________

 

Podium Club © 2006
All Rights Reserved