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Premium List English Cocker Club of America Revised 4/18/17 - HIT English Award PRESIDENT ...... Margie Wilson THREE AKC ALL BREED AGILITY TRIALS PAST PRESIDENT ...... Beth Hendrick Entries will be accepted for listed in the AKC Canine Partners program VICE-PRESIDENT ...... Sandy LaFlamme #2017133210, 2017133211, 2017133212 TREASURER ...... Karen Spurlin RECORDING SECRETARY ...... Jessica Mybeck CORRESPONDING SECRETARY ...... Shannon Loritz 12912 Silver Spring Ln, Battle Creek, MI 49014

Board of Directors Class of 2017: Carol Collins, Chris Dooley, Barbara Martin Clas of 2018: Linda Amick, Doug McFarlane, Kim Wiley

AKC Delegate: Sharon Collins

English Cocker Spaniel Club of America Trial Chair Member of the American Pam Piazza Friday, June 9, 2017 3561 Seiler Rd, Bethalto, IL 62010 618-531-9660 All Standard/JWW classes plus Premier Standard [email protected] Saturday, June 10, 2017 All Standard/JWW classes plus Premier JWW Event Committee Sunday, June 11, 2017 Joyce Geshweiler, Laura Haverstick, Lynn James, Lisa Jones, Pam Piazza Master/Excellent Standard/JWW classes plus Premier Standard/JWW Bob Bruce Chief Course Builder Limited to 330 runs total per day Bryan Murphy Assistant Chief Course Builder excluded on June 9 & 10 Chris Brewer Workers Lisa Jones Awards Sports at Kim’s 1951 Townsley Ln Caseyville, IL 62232

Trials will be held indoors on rubber fl ooring Trial Secretary 80’ x 100’ ring Carolyn Johnson Lab Tested Secretary Services ENTRIES OPEN at 8:00 am CDT, Monday, April 3, 2017 AKC Annually Licensed Agility Trial Secretary Entries accepted on a “FIRST RECEIVED” basis 632 N Forest Ave 314-395-9950 (Tel) with preference for English Cocker - see page 3 Webster Groves, MO 63119 314-222-9212 (FAX) Accepting ENTRIES ONLINE through LabTestedOnline.com http://www.labtestedsecretary.com [email protected]

ENTRIES CLOSE at 6:00 pm CDT, Wednesday, May 24, 2017 After which time entries cannot be accepted, canceled, altered, or substituted except as provided for in Chapter 11, Section 6 of the Rules Applying to Dog Shows and Veterinarian On Call Chapter 1, Section 20-21 of the Regulations for Agility Trials Animal Emergency Center 2005 Mall St Certifi cation Collinsville, IL 62234 618-346-1843 Permission has been granted by the American Kennel Club for holding this event under American Kennel Club Rules Directions from trial site: Turn right onto Bunkum Rd. Turn left onto Hwy 157 for 4 miles. and Regulations. James P. Crowley, Secretary Turn left onto Mall St. Judge & Assignment Class Description Cynthia Blanton #90980 Please see the AKC Regulations for Agility Trials for current class descriptions. Dogs must PO Box 546, 16 Nighthawk, High Rolls Mountain Park, NM be entered only in Regular Classes or Preferred Classes with no crossover between All Classes them allowed at the same set of trials.

Obstacles Entry Fees Obstacles will conform to the requirements in the current edition of the AKC Regulations for First entry per dog per day ...... $20.00 Agility Trials. Each additional entry per dog per day ...... $15.00 Includes AKC Recording Fee of $3.50 for fi rst entry and $3.00 for each additional entry per dog per day. Classes Off ered Regular Agility Entry Method STANDARD: Novice A & B, Open, Excellent, Master, and Premier First Received with preference for English Cocker Spaniels. All entries will be accepted JUMPERS WITH WEAVES: Novice A & B, Open, Excellent, Master, and Premier on the opening date, but only entries for English Cocker Spaniels will be entered into the trial Preferred Agility for the fi rst 2 weeks. All other entries will be put on a waiting list. On April 17 at 8 am CDT, STANDARD: Novice, Open, Excellent, Master, and Premier those entries will be entered in the trial in the order received until the trial limits are reached. JUMPERS WITH WEAVES: Novice, Open, Excellent, Master, and Premier Entries received on or after April 17 at 8 am CDT will be entered in the trial in order of receipt regardless of breed until the trial limits are reached. Dogs Eligible to Enter This trial is open to all dogs fi fteen (15) months of age or older that are registered with the Online Entries American Kennel Club or that have AKC Limited Registration, Purebred Alternative Listing/ This trial is accepting online entries through LabTestedOnline.com. During the fi rst 48 hours Indefi nite Listing Privileges (PAL/ILP) or an AKC Canine Partners listing number, or are ap- after opening, the initial limit of entries designated as either online or paper will be as follows. proved Foundation Stock Service (FSS) breeds. 165 runs online (50%), 165 runs paper (50%) each day. If either form of entry has not fi lled at the end of the 48 hour time period, the club reserves the right to decrease or increase either Dogs with a PAL/ILP number or an AKC Canine Partners listing number must be spayed or one accordingly. neutered in order to compete. Dogs should be physically sound. Dogs that are blind, bitches in season, aggressive dogs, or dogs suff ering from any deformity, injury, or illness which may Paper Entries aff ect a dog’s physical or mental performance are not eligible to compete. No dog shall compete Make checks payable to ECSCA. if it is taped or bandaged in any way or has anything attached to it for medical purposes. Refer Mail entries and fees to: Lab Tested Secretary Services to Chapter 2 of the Rules Applying to Registration and Discipline for the listing of registerable 632 N Forest Ave breeds that may participate. Webster Groves, MO 63119 Wherever the word “dog” is used in these regulations, it includes both sexes. Paper entries received within the fi rst 24 hours must include postage or be metered. Entries must be delivered by multi-state or multi-national postal or carrier service, including but not limited to USPS, FedEx, UPS, and DHL. You must waive the signature requirement for delivery services, if applicable. No fax entries will be accepted. Limit of 10 dogs per envelope. Tentative Running Order All entries must be submitted on offi cial AKC Agility entry forms, one dog per entry form. Class Order - Regular and Preferred will be run together at each height. Photocopies of entry forms without the AKC Agreement are not acceptable. Unsigned, Friday Standard - Master/Excellent, Premier, Open, Novice incomplete, or illegible entries are not acceptable. JWW - Master/Excellent, Open, Novice If you would like confi rmation that your entry was received before the trial has closed, please Saturday JWW - Master/Excellent, Premier, Open, Novice include your email address or enclose a self-addressed stamped postcard. Standard - Master/Excellent, Open, Novice Entries cannot be changed once the trial has closed. Please check your entries! Sunday Standard - Master/Excellent, Premier JWW - Premier, Master/Excellent

“After Closing” Waiting List Jump Order A waiting list (30 run maximum each day) will be maintained for these trials once they have All days Tall to small closed on May 24. The waiting list will be active until its deadline — Monday, June 5, 6:00 pm CDT. Any runs that are entered in these trials at closing and pulled before the waiting list deadline will be replaced, if possible, by runs in order on the waiting list, and the exhibitor will be reimbursed in full. If a run is pulled but cannot be replaced, the exhibitor will not Start Time receive a refund and the dog will be considered absent for the run. Entry fees for runs on Walkthrough/judge’s briefi ng Judging starts the waiting list that do not get into the trial by the waiting list closing date will be refunded in full. All days 7:30 am 8:00 am Height Divisions Prizes and Awards Owners are responsible for entering their dogs in the proper height divisions. Rosettes will be awarded to First Place through Fourth Place in each jump height in each Height divisions are: class. Qualifying ribbons will be awarded to all dogs receiving a qualifying score. Dogs must Dogs Measuring Regular Agility Preferred Agility qualify to receive placement rosettes. at the withers May enter in a higher jump MUST enter the AKC 1st place ...... Blue height than required but not mandated jump height 2nd place ...... Red in a lower jump height 3rd place ...... Yellow 11” and under 8” 4” 4th place ...... White 14” and under 12” 8” Qualifying ...... Green 18” and under 16” 12” 22” and under 20” 16” A MACH ribbon and bar will be awarded to any dog fi nishing a MACH title at these trials. over 22” 24” 20” A PACH ribbon and bar will be awarded to any dog fi nishing a PACH title at these trials. A at owner’s discretion 26” ---- new title ribbon will be awarded to any dog fi nishing a title at these trials. A QQ rosette will be off ered to any dog qualifying in both Master Standard and Master JWW in the same trial. AKC Jump Height Cards All dogs competing in agility must possess an offi cial AKC Jump Height Card. You are not required to show your height card or send a copy with your entry. You are required to High in Trial (English Cocker Spaniel) for each day is determined by combined YPS in mark on your entry form if your dog needs to be measured. For more information please Standard and JWW classes at the Master level. If no Master level dog QQs, consideration visit http://www.akc.org/events/agility/jump_height_card.cfm goes to dogs with Standard and JWW Qs at any other level. If no dog qualifi es in both, high score goes to the dog with the fastest YPS in either Master Standard or Master JWW. If a tie should occur, the dog in the tie with the most Qs, in all off ered classes that day, is awarded HIT.

High in Trial (ECS) ...... English Cocker Spaniel item (minimum $25 value) Move-ups For the Friday trial: MOVE-UPS close at 6:00 pm CDT, Monday, June 5. Move-ups may be sent by regular mail or email to the Trial Secretary. If an email address is provided with your entry, an email confi rmation of the move-up will be sent. For the Saturday and Sunday trials: MOVE-UPS close 30 minutes after the end of the trial on Friday and Saturday respectively and must be submitted at the trial.

Food Vendor Matt “THE CHOWMAN” McDaniel MCM Mobile Catering Change of Entry Serving lunch all 3 days As described in Chapter 1, Section 21 of the Regulations for Agility Trials, a dog which is entered in a Novice A class for which it is not eligible may be moved to Novice B. In addition, if notifi cation has been received in writing from the AKC after closing that a dog is not eligible for a class entered, the dog may be moved to the correct class. The request for the move must be made at least 30 minutes prior to the start of the trial. If a VMO or Field Representative at Volunteers a trial measures a dog into a height other than what they entered, the entry may be changed Volunteers will be needed for the smooth running of this trial. We will send out a link to the from Regular to Preferred or from Preferred to Regular, as long as the dog has not run any worker signup site once the trial has closed. Workers will have access to the hospitality room classes that day. If the dog has already run, the change may be made for the next trial day(s). and will be given tickets for lunch and for the worker rafl les for refund of one dog’s entry fees The exhibitor must provide the Trial Secretary the AKC Agility Measurement Form when and for one day’s entry fees. requesting the class change.

Trial Information The middle room will be available on Thursday, June 8 for set up from 5:30 pm - 6:30 pm. Premium list, entry form, fax form, and directions available at Trial hours are 7:00 am to 30 minutes after the completion of the trial each day. http://www.labtestedsecretary.com Ring size: 80’ x 100’. The building is climate-controlled. There is plenty of close parking and crate space. Please Print entry forms or enter online at bring chairs, crates and water for your dogs, and clean up supplies. http://www.labtestedonline.com Electronic timing will be used at these trials. Notice to Exhibitors Motel Information The safety of the dogs is our primary concern. By entering these trials, exhibitors acknowl- 1. America’s Best Inn, 2423 Old Country Inn Rd, Caseyville, IL 62232 edge that they are familiar with the rules and regulations of this sport and that their dogs 618-397-3300 are familiar with and able to perform all obstacles safely. 2. Motel 6, 2431 Old Country Inn Rd, Caseyville, IL 62232 Entry fees will not be refunded in the event that a dog is absent, disqualifi ed, excused, or 618-397-8867 barred from competition by action of the Event Committee. 3. Super 8 Motel, 45 Ludwig Dr, Fairview Hts, IL 62208 The English Cocker Spaniel Club of America may cancel this event in extreme weather 618-398-8338 conditions. 4. Drury Inn & Suites, 12 Ludwig Dr, Fairview Hts, IL 62208 Entry fees will not be refunded if the trials cannot be opened or completed by reason of riots, 618-398-8530 5. LaQuinta Inn & Suites, 136 Regency Park, O’Fallon, IL 62269 civil disturbance, fi re, an act of God, public emergency, an act of a public enemy, or any 618-726-2323 other cause beyond the control of the organizing committee. 6. LaQuinta Inn & Suites, 6 Gateway Dr, Collinsville, IL 62234 Since bitches in season are not allowed to compete in AKC Agility Trials, the club will refund 618-855-8400 all but $5.00 of the entry fee per day for bitches unable to compete for that reason. The 7. Best Western, 9730 Hayden Dr, Mascoutah, IL 62258 Trial Secretary must receive written notifi cation of such a claim for refund by letter hand- 618-808-0280 delivered, emailed, or postmarked before the trial commences. The club will refund all but $5.00 of the entry fee per day for injured dogs. Written request for NOTE: policy should be confi rmed before making reservations. a refund must be made to the Trial Secretary prior to the start of the fi rst trial day and a veterinarian’s or doctor’s letter must be provided within one week of the trial. It is expressly understood that exhibitors alone are responsible for the behavior of their dogs and/or children. Any exhibitor whose dogs and/or children create unnecessary disturbances RVs There is no RV parking at the trial site. or repeatedly engage in unsafe or disruptive behavior may, at the discretion of the Event Local RV Parks: Committee, be asked to leave the trial site. In such case, no refund of any fees paid will St Louis NE / Granite City KOA, 3157 W Chain of Rocks Rd, Granite City, IL 62040, 800- be made. 562-5861, 618-931-5160, www.koa.com/where/mo/13107/ All dogs must be on leash or crated at all times except when in the ring or when in the des- Cahokia RV Parque, 4060 Mississippi Ave, Cahokia, IL 62206, 618-332-7700 ignated agility warm-up area. Exhibitors are responsible for being at the ring gate when it is their turn to run. The judge need not wait for any dog holding up a class. The English Cocker Spaniel Club of America has no All exhibitors must be responsible for cleaning up after their dogs on the motel, RV and trial grounds. obligation or responsibility for providing service through a public address system or steward Motels require that dogs be crated when unattended. Any damages to motels, RV sites or the trial site can for the purpose of calling or locating dogs that are not brought to the ring when required. result in disciplinary action by the Event Committee. It is expected that exhibitors will clean up immediately Entries must be made on Offi cial AKC entry forms or copies and must include the signed after their own dogs and strongly encourage others to do the same. Agreement and Rules. Junior Handlers must enter their JH# and complete back of form. All owners/exhibitors should be aware that the entire motel grounds and RV sites are considered Include only AKC titles on entries. within the trial grounds. You will be responsible for all damage to your room/site and may be subject to disciplinary action in accordance with the rules of the AKC. Any abuse of the grounds will be brought to All owners of mixed breed dogs must fi rst obtain an AKC Canine Partners listing number the attention of the trial-giving club and its Event Committee. Any exhibitor’s entries may be refused for before they may enter an AKC Agility event. The dog’s breed name should be entered as previous misuse of the motel or RV facilities. This is an AKC supported measure. “All American Dog”. The dog’s listing number must be entered on the entry form and “AKC No.” checked. Owners are responsible for errors in making out entry forms, whoever may have made such errors. No entry will be refunded in the event of such errors or cancellation of entries after the published closing date. Errors in entries made by the exhibitor cannot be corrected Directions after the closing date. No refunds for duplicate entries. From northwest: Take I-270 east to I-255 south. Take I-64 east to Exit 9, IL 157. Turn left onto Dogs under 4 months of age are not permitted on the show grounds of AKC Agility Trials. Hwy 157. Turn left onto New Bunkum Rd (becomes Bunkum Rd). Turn left onto Townsley Rd.

Exhibitors should follow their veterinarians’ recommendation to assure their dogs are free From the west on I-70 or I-64 (downtown St Louis): Take the Stan Musial Bridge (I-70) or the of internal and external parasites and any communicable diseases and have appropriate Poplar Street Bridge (I-64) into Illinois to I-64. Take I-64 east to Exit 6, IL 111/Kingshighway. vaccinations. Turn right onto Bunkum Rd (fi rst intersection). Turn right onto Townsley Rd. Returned checks do not constitute a valid entry fee. There is a $25 returned check fee. No refunds will be issued for overpayment of less than $10. From south/southwest: Take I-55 north to I-255 east. Take I-64 east to Exit 9, IL 157. Turn Exhibitors are responsible for cleaning up after their dog(s). Any exhibitor failing to do so may left onto Hwy 157. Turn left onto New Bunkum Rd (becomes Bunkum Rd). Turn left onto be excused without benefi t of refund if the Event Committee deems the exhibitor to be in Townsley Rd. violation of this requirement. No strollers or playpens will be allowed in the building. From east: Take I-64 west to Exit 9, IL 157. Turn right onto Hwy 157. Turn left onto New No Flexi-leads are permitted in the building. Bunkum Rd (become Bunkum Rd). Turn left onto Townsley Rd. No professional photography or videotaping is permitted without permission. NO SMOKING is allowed in the building. From north: Take I-55 south to I-255 south. Take I-64 east to Exit 9, IL 157. Turn left onto Dogs may not be left in the building overnight. Hwy 157. Turn left onto New Bunkum Rd (becomes Bunkum Rd). Turn left onto Townsley Rd. OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site,www.akc.org AGREEMENT I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered. In English Cocker Spaniel Club of America consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of The American Kennel Club in effect June 9-11, 2017 at the time of this event, and any additional rules and regulations appearing in the premium list of this event and entry form and any Friday ___ Standard ____ JWW ____Prem STD Not off ered decision made in accord with them. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem suffi cient. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. In consideration of Saturday ___ Standard ____ JWW Not off ered ____ Prem JWW the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prizes, ribbons, or Sunday ___ Standard (M/X) ____ JWW (M/X) ____Prem STD ____ Prem JWW trophies, I (we) agree to hold the AKC, the event-giving club, their members, directors, governors, offi cers, agents, superintendents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any Entry fee: $20.00 for the fi rst entry and $15.00 for any additional entry of the same dog each day. Entries open 8:00 am, Apr 3, 2017. Entries employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim close at 6:00 pm, May 24, 2017, at the Agility Trial Secretary’s offi ce. Make checks payable to ECSCA Mail entries with fees to Lab Tested for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or Secretary Services, 632 N Forest Ave, Webster Groves, MO 63119. Express mail entries must include signature permitting them to be left at about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any the Trial Secretary’s address without recipient signature. Checks must be payable in US funds. PLEASE PRINT CLEARLY. such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog. IMPORTANT: Carefully read instructions before fi lling out! ENTRY FEE ENCLOSED for this dog Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless $ from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including Choose Either Regular or Preferred Classes myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however Check one jump height, and check class selections – Only one selection per class (STD, JWW, FAST, T2B) such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have REGULAR Classes PREFERRED Classes been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons. I (we) agree that the determination of whether the injury is serious shall be made by the event veterinarian and is binding on me (us). I (WE) AGREE 8” 12” 16” 20” 24” 26” 4” 8” 12” 16” 20” THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT-GIVING STD NA NB Op Ex M P STD N P Op P Ex P M P PP CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) AND MYSELF (OURSELVES) OR JWW NA NB Op Ex M P JWW N P Op P Ex P M P P P AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBI- FAST NA NB Op Ex M FAST N P Op P Ex P M P TRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE T2B T2BP T2B T2B AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. Non-Regular Classes International Sweepstakes STD JWW INSTRUCTIONS ISC Jump Height - Select: 14” 18” 26” - OR - Jump Height Same as Regular/Preferred Handlers may opt to enter in a higher height division for all Regular titling classes, but not in a division lower SEX HEIGHT AT WITHERS This dog needs to be measured: Yes No than their proper height division. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. BREED VARIETY CALL NAME All dogs that have not been offi cially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Offi cial, AKC® NAME (Include AKC titles only) prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to- back trials only. If a measurement is necessary, it is the exhibitor’s responsibility to have their dog(s) measured (Enter Complete Registration # below) DATE OF BIRTH AKC NO. prior to running. ILP NO. PAL NO. PLACE OF BIRTH (List Country) Dogs listed in the AKC Canine Partners ProgramSM may be eligible to enter all-breed AKC agility trials at FOREIGN REG. NO. the club’s option. These dogs should be listed as All American Dog and must include their AKC number on the BREEDER entry form and check the AKC No. box.

SIRE Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) 233-9767. If the Junior Handler DAM is not the owner of the dog identifi ed on the face of this form, what is the relationship of the Junior Handler to the Owner? ACTUAL OWNERS

SIGNATURE of owner or his agent duly authorized to make this entry. OWNERS ADDRESS NEW ADDRESS SIGN HERE X CITY STATE ZIP + 4 Telephone Number: HANDLER ENTER JR HANDLER # if applicable Email: New Email In Case of Emergency - Name: Phone #: Exhibitor or owner MUST sign on the signature line beneath the instructions. AEAGL2 - (12/13) OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM AGILITY TRIAL -- MOVE-UP ECSCA June 9-11, 2017 ___ Friday ___ Saturday ___ Sunday Mail form to Lab Tested Secretary, 632 N Forest Ave, Webster Groves, MO 63119 AKC REGISTERED NAME (INCLUDE AKC TITLES ONLY) Webster Groves,MO,63119 632 NForest Ave Carolyn Johnson Lab Tested SecretaryServices

AKC REG NO

MOVE STANDARD ENTRY TO: OPEN EXCELLENT MASTER

MOVE JWW ENTRY TO: OPEN EXCELLENT MASTER

MOVE FAST ENTRY TO: NOT OFFERED

ACTUAL OWNER(S)

SIGNATURE OF OWNER OR HIS AGENT DULY AUTHORIZED TO MAKE THIS ENTRY X

For Trial Secretary Use Only: APPROVED:

OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM AGILITY TRIAL -- MOVE-UP ECSCA June 9-11, 2017 ___ Friday ___ Saturday ___ Sunday Mail form to Lab Tested Secretary, 632 N Forest Ave, Webster Groves, MO 63119 AKC REGISTERED NAME (INCLUDE AKC TITLES ONLY)

AKC REG NO

MOVE STANDARD ENTRY TO: OPEN EXCELLENT MASTER

MOVE JWW ENTRY TO: OPEN EXCELLENT MASTER

MOVE FAST ENTRY TO: NOT OFFERED

ACTUAL OWNER(S)

SIGNATURE OF OWNER OR HIS AGENT DULY AUTHORIZED TO MAKE THIS ENTRY X

For Trial Secretary Use Only: APPROVED: