Entry Form

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Circle Titles(s) Sought
IPO-I IPO-II IPO-III OB1 OB2 OB3 TR1 TR2 TR3 BH

***Fees are $50 for any event
***Make checks payable to MidSouth Working Doberman Club
***Send to Larry Kye 114 Chickasaw Place, Jacksonville, AR 72076
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Dog's Registered Name:_____________________________________________
Scorebook Number:_________________________________________________
Microchip#:______________________ Tatoo#: ___________________________
Date of Birth:____/____/____ M/F___Breed:______________________________
Other Foreign Registry & #:____________________________________________
Owner’s Name:_____________________________________________________
Address:__________________________________________________________
Owner’s Phone:______________________ Email: _________________________ Handler’s Name:____________________________________________________
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Note: Scorebook proof issued for dog’s previous performances held by owner or handler must be handed in before the start of the trial.

Release Agreement
I understand that this event will be conducted pursuant to the rules and regulations of the United Doberman Club(UDC). I agree to abide by those rules & regulations. I understand that every dog at this event is required to be under the care & control of its named owner or handler at all times. I understand & agree to be fully responsible for the actions of the dog named above and for the actions of any & all other dogs that I might bring to this event. I agree to indemnify the MidSouth Working Doberman Club, the UDC and any other persons or entitites sponsoring or hosting this event for any loss or injury resulting from my actions or the actions of my dog(s), either directly or indirectly, to any person or thing & to hold the MidSouth Working Doberman Club, the UDC, the officers & directors of the MidSouth Working Dobermand Club and the UDC & and other sponsor or host, harmless for such loss or injury.

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Signature of Owner or Authorized Handler Date