Printable Registration ORT Form

 

Eager Pup, LLC

NACSW™ – Odor Recognition Test 

Sunday, August 5, 2018 

B’nai Israel, 3830 NW 16th Blvd, Gainesville, FL

 

 

$35 Registration Fee per test - Payment by check or money. 

Please mail this completed form via USPS with your registration fee to: 

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

              Checks payable to Eager Pup, LLC             

 

Questions: Contact the ORT Host - Melanie Phillpot, Eager.Pup@hotmail.com, 352-871-5698

 

Odor:            □ Birch -$35                   □ Anise-$35            □ Clove-$35     Total Fees = $35  $70  $105

                                                                                                                         circle one above

Test date:   August 5, 2018                                                                          

 

Dog’s Call Name  ______________________________

One form per dog.  .

Breed(s) ______________________                       Dog’s NACSW™ #________________

Handler’s Name _____________________________________________________ 

Handler’s NACSW™ Membership # (for 2018-2019) year______________________________

 

Address _______________________________________________________

City __________________   State _________      Zip________ 

Phone where you can easily be reached ___(_____)__________________    

E-mail Address _____________________________________________________

 

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 with attachment 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.

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 Eager Pup, LLC, Melanie Phillpot, B’nai Israel and/or NACSW™ 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.

 

 Signature_______________________________        Date:_______________

Check or Money Order Number­­­­____________   Amount $_____________