2016 Northwestern Regional Championship
ONLINE REGISTRATION

INSTRUCTIONS:

Fill out the form below and 'Submit' the information BEFORE paying the trial fees.
Once the form has been submitted, then follow the instructions for payment found below the form.

DOG INFORMATION

Registered Name and Current Titles

Is this dog breed-surveyed?

Please note: a breed survey is not required to enter Regionals. This is for USCA's Highest Scoring Breed Surveyed Dog trophy.

Registration Number and Registry (AKC, SV, etc)

Tattoo or Microchip Number

Scorebook Number

Breed:

Gender

Date of Birth

Entering for Which Title?

Handler Owner Trained (HOT)?

HANDLER INFORMATION

Handler Name

First Name

Last Name

Club Affiliation

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

USCA Membership number and Expiration Date

Club and Date when Handler Earned BH:

Owner Information (if different from Handler)

If the owner of the dog is different from the handler, please include the following: Owner Name (first, last), Contact info, Address, Owner's USCA Membership number and expiration date.

Form of Payment for Registration Fee

LIABILITY WAIVER

All dogs are to be under the control of the handlers/owners at all times. The handlers/owners are fully responsible for the actions of their dogs while on or near the trial grounds and tracking field. Handlers/owners also waive all claims against and shall hold HARMLESS the United Schutzhund Clubs of America (USCA), Placer County Schutzhund Club (PCSC), its members, officers, directors, participants, and property owners, for any accident or injury or loss which may occur on or near the trial grounds--including the tracking field--directly or indirectly, before, during, or after this event. Handlers/owners also further agree to abide by all rules of the United Schutzhund Clubs of America and PCSC. By typing their name below, the handler whose name is listed on this form has indicated that they have read and understand the above rules, and agree to waive all claims against and hold HARMLESS the United Schutzhund Clubs of America (USCA), Placer County Schutzhund Club (PCSC), its members, officers, directors, participants, and property owners, for any accident or injury or loss which may occur on or near the trial grounds and tracking field, directly or indirectly, before, during, or after this event.

PAYMENT INSTRUCTIONS

Please "Submit" your registration information above BEFORE paying your registration fee (otherwise, you lose all the information you painstakingly typed in!).

You may pay your registration fee online using PayPal by clicking the "Buy Now" button below. If you wish to pay by check, please contact our Trial Secretary.

2016 NW Regional Championship Registration Fee: $125

REGISTRATION WILL NOT BE COMPLETE UNTIL RECEIPT OF PAYMENT. There are NO REFUNDS of Trial Registration fees.

Questions? Please contact our Trial Secretary.

Placer County Schutzhund Club

Placer County Schutzhund Club

registration

Placer County Schutzhund Club

2016 Northwestern Regional Championship ONLINE REGISTRATION

INSTRUCTIONS:

PAYMENT INSTRUCTIONS

2016 NW Regional Championship Registration Fee: $125

Placer County Schutzhund Club

2016 Northwestern Regional Championship
ONLINE REGISTRATION