<p> THE TASMANIAN CANINE ASSOCIATION INC</p><p>APPLICATION FOR OBEDIENCE TITLE </p><p>OBEDIENCE: CCD - CD - CDX - UD - UDX – OC RALLY OBEDIENCE: RN- RA- RE- RAE </p><p>AGILITY: AD – ADO- ADX- ADM - AG.CH JUMPING: JD – JDO- JDX - JDM</p><p>AGILITY GAMES: SD- SDX- SDM- GD- GDX- GDM –SPD-SPM-SPE</p><p>TRACKING: TD- TDX- TC TRACK & SEARCH: TSD - TSDX ENDURANCE</p><p>FLYBALL: FD – FDEXC – FD CH (Qualifications gained prior to 01/07/2012)</p><p>DANCES WITH DOGS: DWDF.S- DWDF.N – DWDF.I- DWDF.A- DWDF.CH DWD HTM.S – DWD.HTM.N –DWD.HTM.I- DWD.HTM.A – DWD.HTM.CH</p><p>( PLEASE CIRCLE THE TITLE BEING APPLIED FOR)</p><p>I/we hereby make application for the Australian National Kennel Council title indicated above for the dog, the particulars of which are as follows:</p><p>NAME OF DOG: ______REG.NO: ______</p><p>BREED: ______SEX: ______</p><p>BREEDER: ______OWNER: ______</p><p>OWNER'S ADDRESS: ______CERTIFICATES WON</p><p>CLUB/SOCIETY DATE JUDGE PTS. / PLACING</p><p>I/we certify the foregoing particulars to be true and correct.</p><p>______Signature/s Date</p><p>FEES: TITLES $27.00 (Fee Inclusive of GST)</p><p>PLEASE FORWARD TO: TASMANIAN CANINE ASSOCIATION INC, PO BOX 116, GLENORCHY Tas. 7010 Phone: (03) 62 72 9443 CERTIFICATE OF REGISTRATION AND PEDIGREE MUST BE ENCLOSED WITH THIS APPLICATION.</p><p>PAYMENT BY CREDIT CARD</p><p>Please debit my Mastercard Visa For the amount of $______</p><p>Card expiry date _____/______CVC Number______(Last 3 digits on reverse of card)</p><p>Card Holder Name: ______</p><p>Signature: ______</p>