Irish Setter Club of America, Inc
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IRISH SETTER CLUB OF AMERICA, INC. SPECIAL AWARDS – 2012 ANNUAL AWARDS APPLICATION FIELD, OBEDIENCE, RALLY & AGILITY AWARDS ONLY (Submit separate forms for each award – Please do not apply for medallions on this form) THIS IS AN INTERACTIVE FORM PLEASE CLICK ON THE GRAY BOX AND TYPE YOUR INFORMATION
Name of 2012 Award Dog’s Name Sex Date of Birth Breeder AKC Reg # [MUST BE INCLUDED] Email Phone Owner Address
Show Name of Club/Trial Score Points Date
Total score, seconds under time, number of dogs defeated or wins applicable to above award: NOTE: You must be a current member and have renewed your dues by January 31, 2012. All owners and co-owners must be members in 2011 and 2012.
Mail postmarked by February 28, 2012 Debbie Davis, 3372 Breezewood Ct, Ortonville, MI 48462
Use second page if needed for more shows for this award only. New form must be used if different award.
Show Date Name of Club/Trial Class/Stake Placement Points