Trial Entry Form

1) Complete all fields
2) Click Submit
3) Make Payment by choosing the appropriate option below the trial entry form and submitting payment. Registration is not complete until payment is made.

Download May 25th Trial Entry Form and Trial Flyer here:

May 25th, 2019 Trial Entry Form
May 25th, 2019 Trial Flyer

Handler & Dog Information
Handler's Name*
First Last
Email*
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Club Affiliation*
Previous Titles and Date of BH*
Dog's Registered Name*
Dog's Gender*
Dog's DOB*
Scorebook Number*
USCA Member Number
Breed*
Registration Number*
Tatoo or Microchip Number*
Trials & Payment Information
BH
Price: $65.00 Quantity:
UPR (OB)
Price: $65.00 Quantity:
FPR (TR)
Price: $65.00 Quantity:
AD
Price: $70.00 Quantity:
IPO Title - IPO 1
Price: $70.00 Quantity:
IPO Title - IPO 2
Price: $70.00 Quantity:
IPO Title - IPO 3
Price: $70.00 Quantity:
APR Title - APR1
Price: $70.00 Quantity:
APR Title - APR2
Price: $70.00 Quantity:
APR Title - APR3
Price: $70.00 Quantity:
FH Title - FH1
Price: $70.00 Quantity:
FH Title - FH2
Price: $70.00 Quantity:
FH Title - IPOFH
Price: $70.00 Quantity:
NOTE: there is a $10 late fee AND a $25 non USCA member fee that must be paid separately if those fees apply.
Add Late Fee
Price: $10.00 Quantity:
Add non-member fee
Price: $100.00 Quantity:
Total
$0.00
Once you submit this donation form, please complete your payment via the Liberty Working Dog Club PayPal account on the next page.
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Trial Entry Form

Handler & Dog Information

Trials & Payment Information