Janet E Larson Versatile BC Award - Entry Form
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OWNER(S):
ADDRESS:
CITY/STATE/ZIP:

TELEPHONE:

E-MAIL:   
REGISTERED NAME:
CALL NAME/SEX:   Dog   Bitch
VENUES AND
CLASSES ENTERED:
Agility - Classes:
Agility Preferred - Classes:
Conformation - Classes:
Herding - Classes:
Obedience - Classes:
Tracking - NOT OFFERED 2012:
AMOUNT ENCLOSED: Fee $10
PAYMENT METHOD: Check US Mail to BCSA Treasurer, 4729 Old Highgate Entry, Stone Mountain GA 30083
Credit Payment (print form and then click Shopping Cart)

 

SIGNATURE: _________________________________________    DATE:
You MUST be pre-registered to be eligible!
Mail entry to: Lisa Pruka, 10321 Harrison Rd, Rockton IL 61072
Mail $10 entry fee payable to BCSA to: BCSA Treasurer, 4729 Old Highgate Entry, Stone Mountain GA 30083
ENTRY DEADLINE September 19

Office Use Only: Received _______________________