Dog’s Registered Name  Birthdate 

AKC, SV or FCI Registration # USCA Registrations not acceptable

Sex   Tattoo or Chip# Scorebook #

Hip Rating (check one box only):Nonea normalfast normalnoch zugelassen OFA ExcellentOFA GoodOFA Fair

Elbow Rating (check one box only):None normalfast normalnoch zugelassen

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

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

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Long Coat 6-12 Months    Long Coat 12-24 Months    Long Coat 2 Years & Up

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  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.)