VERSATILITY PROGRAM - "VX" AWARD APPLICATION
Maximize page for easier entry.  

Type your "VX" application information in the fields below and then select "print" from your browser.  Send this application and worksheet (Adobe PDF) along with verification of titles (photocopies of title certificates, AKC Gazette pages listing titles or AKC report available from their on-line store) to: Tashia Lund, PO Box 153, Gilby, ND 58235-0153.  DO NOT send original title certificates as they can not be returned.  If you have any questions, e-mail Tashia Lund.  Thank you.

(R) = Required Information
BCSA Member's Name:     (R)
Street Address:   (R)
City:    State        Zip:      (R)
Home Phone:   (R)  Work Phone:
E-mail:
 
Dog's Registered Name
(including titles):		    (R)
Dog's Information:

Note: Dog must have valid OFA/CERF numbers or be spayed/neutered.
OFA#:   CERF #:  

 
Award Preference:   (R)
Name of Actual Owner: (R)
 
Member's Signature:   ___________________________________________________  Date:   (R)

Please note: This is the application for the "VX" Award.  It may not be used for the V or VCH award.  All Versatility awards issued after Nov. 2, 2000 must use this application form/worksheet and are subject to the revised requirements. Applications on old forms will not be honored.

Page Updated 05.02.2008