Trial Entry Form
Select the event:    
BREED: VARIETY:
GENDER: Male      Female DOB: (format 2014-01-24)
TITLES BEFORE:
NAME OF DOG: (Call name for unregistered dogs)
TITLES AFTER:
REGISTRATION NUMBER:   Not Registered
CALL NAME:
REGISTRATION ORGANIZATION:
PLACE OF BIRTH:(USA, Canada, etc)



BREEDER:
SIRE:
DAM:



HANDLER(S):   MEMBERSHIP #:
ADDRESS:
CITY: ST: ZIP:
TELEPHONE:
EMAIL:



ACTUAL OWNER(S):     Same as Handler
ADDRESS:
CITY: ST: ZIP:
TELEPHONE:
EMAIL:



LEVEL:
Select an Event Above
Mar 15, 2018 Mar 16/17, 2018
Decoy Seminar
Decoy Certification

Click the checkbox for each event and date(s) you wish to enter.


Total Entry Fees:
COB Total:    Only applies when paying via PayPal
Late Fees:    Only applies when paying AFTER the closing date
Total:
NOTE: If the total is incorrect, you will be able to alter it on the next page after submitting your entry



I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above.
By signing this form containing a release and waiver of all liability and being permitted to participate in the event, I expressly agree to waive the right to assert any claim, action, or lawsuit and expressly agree to release, remise and to indemnify and hold harmless PSA, the sponsoring club/organization and its officers and members, landowners/ property lessors, and any approved PSA Judge or PSA representative from any such claim, action or lawsuit seeking legal damages in any form as a result of participation in this event which might be made or asserted by myself, or which might be asserted on behalf of any minor child or any other person/agent participating in the event on my behalf. I further agree by signing this form to waive and release any claim for damages or other form of legal relief based on any action, decision, or judgment made by any PSA or host club representative or any decision made by any approved PSA Judge pursuant to the official PSA Rules and Regulations governing this event.
I agree to abide by the Rules and Regulations of the national organization in effect at the time of the Test/Trial and by any additional rules and regulations appearing in the program or on the internet for this Test/Trial or both. I certify and represent that the dog entered is not a hazard to persons or other dogs. It is understood that every dog at this event will at all times be in the care and control of the dog's handler. It is further understood that the undersigned agrees to be fully responsible of the actions of his/her dog(s) while at this event.
SIGNATURE of owner or agent duly authorized to make this entry.

Signature: ______________________________________________     For mailed applications only

Contact information of Owner and/or agent:
(online application will not be accepted if missing this information)
Print Name:
Email:
Phone #:
Date:
Electronic Signature: By typing your name above (under print name) and checking this box you are stating you are the person above, and that you have read and agree to all statements on this application, and that all information supplied is accurate to the best of your knowledge:     (THIS BOX MUST BE CHECKED FOR YOUR APPLICATION TO BE ACCEPTED!)


Payment Options and other Instructions

IMPORTANT INFORMATION:
All entries received by the pre-entry closing date for this event have been sponsored, i.e. FREE. In an effort to prevent people from entering dogs and then not showing up, thereby preventing another competitor from being able to enter, a credit card number is required to hold your entry. If a cancellation notice is NOT received by Sept 10th, and the maximum allowed entries was reached, your card will be charged the late fee for each entry made. This money will then be used to sponsor another competitor who was unable to enter by the pre-entry closing date, due to the maximum number of entries having been reached.
By submitting this entry form, you agree to these terms.

Enter your credit card number, expiration date, and security code from the back of the card:


You may want to save a copy of this form for your records before you hit submit.

Notes (enter the dog you are bringing or if you need a dog):


 
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