OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM Note: This Entry Form Must Be Completed in Full FOR FIELD TRIALS/HUNTING TEST

VIZSLA CLUB OF NORTHERN NEW JERSEY. AKC MEMBER CLUB

Location TBD

I SUBMIT $_________________for entry fees.

Enter in stake/test ______________________________________________________________

NAME OF DOG (Print)

AKC Reg. Number Or AKC Litter Number (If Dog Not Reg.) Or Foreign Reg. Number And Country of Registry

Breed Male  [  ] Female [  ] Date of Birth

Sire

Dam

Breeder

Name of Actual Owner (Print)

Owner's Address Street

City State Zip Code

Name of Handler (Print)

FOR RETRIEVER TRIALS ONLY: THIS IS TO CERTIFY THAT THIS DOG IS  [  ] IS NOT  [  ] QUALIFIED FOR A LIMITED ALL-AGE STAKE THIS DOG IS   [  ] IS NOT  [  ] QUALIFIED FOR A SPECIAL ALL-AGE STAKE

I CERTIFY that I am the actual owner of this dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. I further acknowledge that the Rules and Regulations of the American Kennel Club governing this event have been made available to me (us) and that I am (we are) familiar with their contents.  In consideration of the acceptance of this entry, I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to descipline) and to abide by any decisions made in accord with them. I (we) further agree that the above named dog is entered in  and will be at this event at my (our) own risk and that I (we) will hold the event-giving club, its members, and agents free from any liability for any claims arising out of the entry of the dog or its presence at the event.

SIGNATURE of Owner or Agent Duly Authorized to Make This Entry

Address of Agent (If Agent Signs Above Line for Owner) Phone No.

Street

City  State Zip Code

AFN999 (9/99)