CKC Entry Form

Official Canadian Kennel Club Entry Form

[___]Show#1 [___]Show#2 [___]Show#3

Prepaid Catalogue [_________]

Total Fee:$____________ Entry Fee:$_____________ Listing Fee:$___________

Place of Birth [___] Canada [___]Elsewhere Check one and Enter Number here: [___]CKC Registration Number	Date of Birth	Is this a puppy? [___]Yes [___]No Sex ____
[___]CKC ERN Number	[___]Day
[___]CKC Misc Cert.	[___]Month
[___]Listed	[___]Year

BREEDER(S)

Sire:

Dam:

Reg'd Owner Name:
Address:
City:	Prov:	Postal Code
Name of Owners Agent:
Agent's Address:
City:	Prov:	Postal Code
Mail I.D. to: [ ______]Owner or [_____]Agent (only 1 ID mailed)

Fax Entry Info:	[_____] Visa	[_____] Mastercard
Card #		Expiry: / /
Card Holder Name:
I Certify that I am the registered owner(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered aboveand accept full responsibility for all statements made in this entry. In consideration of the acceptance of this enty, I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additional rules and rugulations appearing in the premium list.

Signature of Owner or Agent Telephone

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