EAST WISCONSIN WORKING BOXER KLUB

Member United States Boxer Association (AWDF)

N1036 MINK LANE CAMPBELLSPORT, WI 53010

MONDAY JUNE 1, 2009

USA JUDGE: JOHANNES GREWE

SEND ENTRY WITH FEES PAYABLE TO EWWBK TO: MINNA NOUSIAINEN-BECHER
N1036 MINK LANE, CAMPBELLSPORT, WI 53010
Ph. (920) 858-2568 Email: boxnen@gmail.com (subject : EWWBK Trial)

$55.00 SCHH 1_____ SCHH 2______ SCHH 3 ______ IPO 1 ______ IPO 2______ IPO 3______ RH1______ FH1______

$45.00 BH______ TR 1______ TR 2______ TR 3______ OB 1______ OB 2______ OB 3______

$45.00 RAS 1______ RAS 2______ RAS 3______ LUNCH $5/PERSON _____

$5 registration fee for non – AWDF/USA-BOX scorebook _______ $5 Written Test Fee BH ________

USA-BOX MEMBERSHIP # ________ USA-BOX SCOREBOOK # ________ TATTOO/CHIP: __________________

MEMBERSHIP (OTHER) _____________ ORG. NAME _______________ SCOREBOOK (Other) _______________

REGISTERED NAME OF DOG CALL NAME

BREED SEX DATE OF BIRTH 

OWNER(S) NAME

ADDRESS

CITY, STATE, ZIP

PHONE EMAIL

HANDLER NAME TOTAL FEES ENCLOSED

The undersigned agrees to be fully responsible for the actions of his/her dogs(s) and to keep them under control at all times. All participants must agree to
conduct themselves in a sportsmanlike manner during this entire event. Any dogs brought to the trial site MUST have proof of vaccinations. I agree to hold
the East Wisconsin Working Boxer Klub, their members, officers, directors, as well as any ground or property owners, harmless for loss or injury which may
have allegedly been caused directly or indirectly to any person or thing by any act of this dog while on the trial premises during trial hours. I hereby agree to
personally assume all responsibility and liability for any such claim. No dog will be allowed to compete without scorebook stamped by USA-BOX.
SIGNATURE OF OWNER
OR AGENT AUTHORIZED TO MAKE THIS ENTRY____________________________________________________ DATE ____________