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OFFICIAL CANADIAN KENNEL CLUB ENTRY FORM
CONFORMATION

ST. CATHARINES & DISTRICT KENNEL & OBEDIENCE CLUB

CLOSING DATE: 8 p.m.
WEDNESDAY, August 1st, 2007

Make fees payable to: St. Catharines
& District Kennel & Obedience Club
and mail to:
MJN Show Services
9 Samya Court,
Scarborough, ON M1R 2A4

[ ] Friday, Aug. 17, 2007

[ ] Saturday, Aug. 18, 2007

[ ] Sunday, Aug. 19, 2007

Please type or print clearly

ENTRY FEES
($25.00/show)
LISTING FEES
($8.48/show)

EXHIBITION ONLY
($25.00 each)

CATALOGUE
($7.00 each)

TOTAL
enclosed

$____________

$____________

$____________

$____________

$____________

BREED VARIETY SEX
Enter in the following Classes:
[ ] Junior Puppy
[ ] Senior Puppy
[ ] Canadian Bred
[ ] Bred By Exhibitor
[ ] Open
[ ] Specials Only
[ ] Exhibition Only
Reg. Name of Dog
Check One - and - Enter Number here

[ ] CKC REG. No.
[ ] CKC ERN No.
[ ] CKC Mis. Cert. No.
[ ] Listed

DATE OF BIRTH Is this a puppy?

D______M______Y_____ YES______NO______

Place of birth

[ ] Canada. [ ] Elsewhere
Breeder(s)____________________________________________________________________________
Sire_________________________________________________________________________________
Dam_________________________________________________________________________________
Reg'd Owners(s)________________________________________________________________________
Owner's Address_____________________________________________________________________
City_____________________________________Prov.______________Code_____________________
Name of Owner's Agent (if any) at the Show__________________________________________________
Agent's Address________________________________________________________________________
City______________________________________Prov._______________Code____________________
Mail I.D. to [ ] Owner or [ ] Agent

I CERTIFY that I am the registered owners(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additonal rules and regulations appearing in the premium list.

______________________________________________________________________________
SIGNATURE OF OWNER OR AGENT TELEPHONE NUMBER
1