Enter the date(s) of show:  (Friday 8/22/08, Saturday 8/23/08 and/or Sunday 8/24/08)

Dog's Registered Name:

Name
Date of Birth
Sex	Male Female
ISSR Number

Place of birth:

Sire's Registered Name:

Name

Dam's Registered Name:

Name

Class Entered: (Age as of day of show)

2-4 months 4-6 months 6-9 months 9-12 months Novice (Adult) American Bred (Adult) Bred By (Adult) Open (Adult) Breed Club Champion (Adult)

Additional Special Classes (National only):

N/A Pee Wee Handling Junior Handling Senior Handling Junior Veterans Senior Veterans

Breeder:

Name
Home Phone

Owner:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone

Co-owner (if applicable)

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone

Name of owner's agent at show (if any)

Name

I have read and agree to the terms on page 2 of the entry form.

Yes
No