BCSA: National Specialty

BCSA Herding Instinct Testing - Entry Form
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NOTE:

ENTER INFORMATION BELOW AS YOU WOULD LIKE
FOR IT TO APPEAR ON CERTIFICATE

OWNER(S):

ADDRESS:

CITY/STATE/ZIP:

TELEPHONE:

E-MAIL:

CONFIRM E-MAIL:

REGISTERED NAME:

CALL NAME:

REGISTRATION NO:

INDICATE TIMES
YOU WOULD BE
AVAILABLE THURSDAY:

8:00-9:00	9:00-10:00	10:00-11:00	11:00-12:00
1:30-2:30	2:30-3:30	3:30-4:30	4:30-5:00

SIGNATURE: _________________________________________ DATE:

ENCLOSED:

Send entry and check ($25 per dog and $10 per rescue dog) payable to BCSA to:
Denise Teal – 15641 State Route 105 – Elmore OH 43416

Office Use Only: Received _______________________ Check #: _____