<p> 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</p><p>Name of 2012 Award Dog’s Name Sex Date of Birth Breeder AKC Reg # [MUST BE INCLUDED] Email Phone Owner Address </p><p>Show Name of Club/Trial Score Points Date</p><p>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.</p><p>Mail postmarked by February 28, 2012 Debbie Davis, 3372 Breezewood Ct, Ortonville, MI 48462</p><p>Use second page if needed for more shows for this award only. New form must be used if different award.</p><p>Show Date Name of Club/Trial Class/Stake Placement Points </p>