SoCal NAVHDA December 6-8, 2024, Test Entry Form

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Please fill out all fields on this form for each dog that will be entered in the test. Once completed please submit form. The Test Secretary will review form and be in contact with you with instructions to complete payment.

Email *

Owners Information

Owner's Name (first and last) *

Owner's NAVHDA Member Number *

Owner's NAVHDA Membership Expiration Date *

YYYY

Owner's Cell Phone Number (Contact on Test Day) *

What Test will the dog be entered in? *

UPT

Dog's Information

Dog's Registered Name *

Dog's Call Name *

Breed of Dog *

Dogs Sex *

Male

Female

Dog's Whelp Date: *

YYYY

Dog's Age on Test Day in Years and Months (YY/MM) Format *

Dogs NAVHDA Registry # *

Is It Possible That Your Female Could Be In Season during the test? *

Yes

Handlers Information

Handlers Full Name: *

Same As Owner

Other:

Handlers Email: *

Same As Owner

Other:

Handlers Cell Phone Number (Contact on Day of Test) *

Same As Owner

Other:

Handlers NAVHDA Member Number

Same as Owner

Other:

Clear selection

Handlers NAVHDA Membership Expiration Date?

YYYY

Is The Handler under the age of 19 years old? *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

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