Enter on Line Form

ENTER ON LINE

Fill out the entry form below for each dog entered (click the Reset Button at the bottom of the page to enter the next dog's information), click the Record Your Entry button at the bottom of the page to submit your entry. Once you reach the Form Conformation Page, please check your entry for any errors. If an error is found simply return to this page, correct the error and resubmit. Print a copy of the final entry for your records; return to this page to pay for your entry.

After you have successfully made an entry and printed it for your records or faxed your entries, 661-224-1906, click on the "Buy Now" button below.

PAY FOR ALL YOUR ENTRIES at ONE TIME on LINE
using a Credit/Debit Card thru PayPal
(you do not need a PayPal account to use this service)
Click on the Buy Now Button below to begin.

A $5.00 convenience fee is charged per transaction when using this service

- Only One Entry Required Per Dog -
Please Refer to the Premium List for Available Classes and Entry Fees

Club/Event Name:
Show/Event Date:

Breed	Variety	Sex

Dog Show Class	Class Division

Additional Classes	Obedience Trial Class	Rally Class	Jump Height

Jr. Showmanship Class	Jr's Name	Jr's ID Number	Jr's Birth Date

Full Name of Dog

AKC REG Number		DATE OF BIRTH
AKC LITTER Number
ILP Number		PLACE OF BIRTH
FOREIGN Reg No & Country Name		USACanadaForeign

Breeder

Sire

Dam

Actual Owner(s)

Owner's Address

City / State / Zip

Name of Owner's Agent (if any) at the Show

Telephone	E-Mail


The AKC Junior Handler Number MUST be included. Should you not have your Junior Handler number, this may be obtained from the American Kennel Club. Phone: (919) 816-3776, email: juniors@akc.org
If Jr. Handler is not the owner of the dog identified on this form, what is the relationship of the Junior to the owner?

I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this event, and by any additional rules and regulations appearing in the premium list for this event, and further agree to be bound by the "Agreement" printed on the reverse side of the AKC ENTRY FORM. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the foregoing representation and Agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them.
Back of Entry Form Agreement

I agree to and accept the above terms.

Contact
Sharon Licciardi, Event Secretary
motherhen@pacbell.net
fax: 661-224-1906

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