Dog’s Registered Name  Birthdate 

AKC, SV or FCI Registration # USCA Registrations not acceptable

Sex   Tattoo # Scorebook #

Current Titles   KKL Rating

Sire's Name Reg # Titles

Dam's Name Reg # Titles

Owner's Name WDA Membership #

Street Address & City   

 State    Zipcode E-Mail Address

Phone

Breeder's Name & Address (City, State or Country

I AM ENTERING MY DOG IN THE (CHECK ONE BOX ONLY)

3-6 Month Class     6-9 Month Class     9-12 Month Class     12-18 Month Class

18-24 Month Class     2 Yrs & Up Untitled Class 2 Yrs & Up with Title

  Veteran's Class 6 Yrs & Up with Title     New Breed Survey     Re-Survey     AD

REMEMBER, YOU MAY REGISTER & PAY ONLINE, BUT YOUR ENTRY IS NOT COMPLETE UNTIL WE RECEIVE YOUR SIGNED SHOW ENTRY ALONG WITH COPIES OF ALL REQUIRED DOCUMENTS and PAYMENT (if you have not already paid.)