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Clever Canine Companions Title Submission Form

Please attach proof for each item listed and use a separate form for each dog
Owners Name: _______________________________________________________
Address: ____________________________________________________________
____________________________________________________________________
Phone Number:_______________________________________________________
(Please specify whether day or evening number)
E-Mail Address: ______________________________________________________
Dogs Registered Name: _______________________________________________
(as you would like it printed on your certificate)
Dogs Call Name: _____________________________________________________
Dogs Breed or Mix: __________________________________________________
Dogs Age:

_________________ Spayed/Neutered? _____________________

Please submit
completed application
with all proofs and
check in the amount
of $15.00 per title
payable to Arleen
Ravanelli.
Please mail to her at:
573 Spring Lake Road,
Rhinelander, WI 54501

Which Title are you applying for? _______________________________________


Category 1 Public Education / Communities Service (3 proofs needed for Category 1)
,

1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 2 Health
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 3 Obedience / Rally


1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 4 Tracking
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 5 Conformation
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 6 Herding
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 7 Protection
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 8 Dog Sports


1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 9 Draft Work


1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 10 Soundness
1 __________________________

2 _________________________

4 __________________________

5 _________________________

Category 11 Service or Therapy Dog Work


1 __________________________ 2 _________________________
4 __________________________

5 _________________________

Category 12 Other
1 __________________________

2 _________________________

4 __________________________

5 _________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

3 ________________________

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