OFFICIAL AKC LC ENTRY FORM Perry Georgia 2016
Entry form for AKC Lure Coursing Events including All Breed Coursing Ability
STAKES *
What exactly are you entering your dog in? CAT is for ALL breeds of dogs, including mixed breeds. All other choices are for Sighthounds ONLY
Required
WHICH EVENTS ARE YOU ENTERING *
Required
BREED OF DOG *
Your answer
REGISTRATION NUMBER (no spaces or /'s ) *
Your answer
REGISTERED NAME OF DOG *
Your answer
CALL NAME OF DOG *
Your answer
DATE OF BIRTH ( or "GATCHA" Day ) MUST be at least 1 year of age *
MM
/
DD
/
YYYY
Height of Dog *
Dogs under 12" or Brachycephalic run 300 yards. Dogs over 12" run 600 yards. Dogs 7 years and over can run a shorter "VETERAN" distance
Required
OWNERS NAME (in the case of multiple owners - please list the MAIN name) *
Your answer
OWNERS STREET ADDRESS *
Your answer
CITY *
Your answer
STATE *
Your answer
ZIP CODE *
Your answer
PHONE NUMBER (example: 1234567890 - no spaces or dashes) *
Your answer
EMAIL ADDRESS *
Your answer
SEPARATE MY ENTRIES
If you have multiple dogs and no help, then we will be happy to put a few dogs in between to give you some time to switch them out
PAYMENT TYPE -EARLY ENTRY CAT are $20/run/dog. JC/QC's are $15.00 If paying with Credit Card $1 is added to each entry. *
If paying by Check - please make payable to GANG and mail to Sharon Webb 6070 Cherokee Trace Cumming, GA 30041
Required
Check Amount and Number
I am paying by check (payable to GANG)
Your answer
SIGNATURE (Please type in your name as you would normally sign it) *
Your answer
I have read, understood and agree to the AKC Rules, Regulations, Policies and Guidelines *
AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org AGREEMENT 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 any additional rules and regulations appearing in the premium list of this event and entry form and any decision made in accord with them. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their mem- bers, directors, governors, officers, agents, superintendents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harm- less from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibil- ity for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the afore- mentioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTER- PRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBI- TRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.
IMPORTANT Payment Info.
If you are paying by check - please make payable to GANG and send payment to Sharon Webb 6070 Cherokee Trace Cumming, GA 30041
Your answer
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