ORT Registration Form - 4 August 2019

 

Electronic Registration at EagerPup.com

 

 

COPY, PASTE and MAIL IN REGISTRATION FORM BELOW

 

 

Eager Pup, LLC

NACSW™ – Odor Recognition Test

Birch, Anise, Clove

August 4, 2019

 

Eager Pup Dog Training Studio

5000 NW 34th Blvd, Suites 3 & 4, Gainesville, FL 32605

(Use 5004 NW 34th Street for GPS directions)

 

$35 Registration Fee per Odor Test

Payment by check or money order payable to Eager Pup, LLC

or by PayPal (no PayPal account necessary) ~ link provided upon electronic receipt of registration form.

 

Use the electronic registration form at EagerPup.com

-or-

Mail this completed paper registration form via USPS with your registration fee to:

(Check or money order payable to Eager Pup, LLC)

Melanie Phillpot, 4237 NW 55th Way, Gainesville, FL 32606

 

Questions: Contact Melanie Phillpot, Eager.Pup@hotmail.com

 

Odor: (check all that apply) □ Birch □ Anise □ Clove

 

Dog’s Call Name _____________________________________________________

 

Breed(s) ____________________________________________________________

 

Dog’s NACSW™ #____________________________________________________

 

Handler’s Name ______________________________________________________

 

Handler’s NACSW™ Membership # _______________________________________

 

Email Address _________________________________________________________

 

Home Address_______________________________________________________________

 

City __________________ State _________ Zip_____________

 

Phone where you can easily be reached _____________________________________

 

Be sure to sign and date the waiver below.

An ORT must be taken and passed at least 14 days before a trial opening date to be eligible for the first draw period.

 

Please contact your host at least 1 day before the ORT if your female dog will be in season.

 

All confirmations will be sent via e-mail within 7 days of receipt of complete registration form and payment. If you require a confirmation via USPS, you must provide a self-addressed stamped envelope. NOTE THAT THE TEST SECRETARY WILL BE UNAVAILABLE FROM JUNE 24 - JULY 5. MAIL-IN ENTRY CONFIMATION MAY BE DELAYED DURING THAT PERIOD.

 

WAIVER

I/We hereby assume all risks of, and responsibility for, accidents and/or damage to myself or to my property or to others, resulting from the actions of my dog. I/We expressly agree that Melanie Phillpot; Eager Pup, LLC; and/or NACSW™; Melody’s Memories; Dalvar, Inc. or any other person, or persons, of said groups, shall not be held liable personally, or collectively, under any circumstances, for injury, and/or damage to my person, for loss or injury to my property, whether due to uncontrolled dogs or negligence of any member of said groups, or any other cause, or causes.

 

Signed: ___________________________________Date: ______________________