Sunday, December 7, 2014 Leesburg, VA with UScA/SV Judge William Szentmiklosi TRIAL LOCATION: TRIAL HELPERS: TRIAL REGISTRATION: TRACKING START TIME: 21900 Foxden Lane, Leesburg, VA 20175 Brandon Jensen & Marty Segretto 7:00 am 8:00 am, with Obedience and Protection to follow MAIL ENTRIES: c/o Marty Segretto 6101 Pine Crest Lane, Frederick, Md. 21701 email: [email protected] MAKE CHECKS PAYABLE TO: DOG-FRIENDLY LODGING: Alexandria Schutzhund Group Days Inn, 721 East Market Street, Leesburg, VA 20176 (703) 777-6622 Sunday, December 7, 2014 I am registering for (please circle appropriate title): $65 – IPO $55 – BH I II III OB1 OB2 OB3 NOTE: There will be a $15 late fee for entries postmarked after November 28, 2014. Non-UScA members will be charged an additional $15 entry fee. (This surcharge is not ASG’s choice, but a UScA ruling.) Owner’s/Handler’s Statement I understand participation at this trial is at my own risk. I will not hold ‘Alexandria Schutzhund Verein’ or any of its members responsible for damages that may occur to my person or property or dog as a result of this club. I understand that I am fully responsible for the actions of my dog. All entries made in this application from are true and correct. I verify that the dog attending has all vaccinations up to date. It is also understood by every handler/owner and exhibitor that every dog at this trial will at all times be in the care, control and custody of the owner and also agree to assume full responsibility for the dog and its actions at all times. Please arrive before 7 am to register. Print and fill out the form completely. ______________________________________________ Dog’s Registered Name ______________________________________________ Scorebook # Chip/Tattoo # ______________________________________________ Date of Birth M F Breed ______________________________________________ Reg # (AKC / SV / Other) H.O.T.? ______________________________________________ Dog’s Previous Titles ______________________________________________ Owner’s Name & UScA member # ______________________________________________ Owner’s Address ______________________________________________ Owner’s Phone Number Owner’s Email ______________________________________________ Handler’s Name & UScA member # ______________________________________________ Handler’s Address ______________________________________________ Date Print Name ______________________________________________ Handler’s Phone Number Handler’s Email ______________________________________________ Owner/Handler Signature ______________________________________________ MAIL TO: Marty Segretto 6101 Pine Crest Lane, Frederick, Md. 21701 Foreign scorebooks, DVG Scorebooks, AWDF Scorebooks and all other FCI approved scorebooks must be approved and certified by USCA and given a number. A $50 scorebook bond will be collected from the handler if a dog is shown without a USA scorebook or a USA certified foreign scorebook being presented to the Trial Secretary prior to the start of the event.