FMBB IGP Declaration

IGP III Declaration Form for the 2021 FMBB World Championship

Deadline: January 15, 2021
Admin Use
Handler Name *

First Name Last Name
Handler Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Handler Email *
example@example.com
Handler Phone Number *

Area Code Phone Number
Handler AWMA Member # *
Handler and Owner are the same? *

Yes No
Owner Name *

First Name Last Name
Owner Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Owner Email *
example@example.com
Owner Phone Number *

Area Code Phone Number
Owner AWMA Member # *
Registered Name of Dog *
The name as it appears on your registration certificate.
Registration # *
AKC Registration, or FCI Country Registration
Registration Organization *
AKC or FCI
Dog's Gender *

Dog (Male) Bitch (Female)
Dog's Birth Date *

Month Day Year
Date
Dog's Microchip # *
Dog's Microchip Type *
Avid, HomeAgain, etc.
Registered Name of Sire *
Registered Name of Dam *
Scorebook Number *
Scorebook Type *
AWMA, DVG, etc.
Current Titles *
Photo of Dog's FCI Recognized registration *

Browse Files
Sample of photo of registration below. Registration number circled in red. Cancel of
Photo of Dog's FCI Recognized 4 Generation Pedigree *

Browse Files

Cancel of
Photo of Dog's Current Rabies Certificate *

Browse Files

Cancel of
Photo of Dog's Scorebook *

Browse Files
Please include both the front info pages along with any pages that have the applicable trial and score information you want to be used in consideration for this event. See examples below. Cancel of
High Resolution Photo of You *

Browse Files
For use in any FMBB/AWMA publications, advertising, etc. Cancel of
High Resolution Photo of the Dog *

Browse Files
For use in any FMBB/AWMA publications, advertising, etc. Cancel of
By signing below I agree and understand that this is a declaration of my intent to be considered for the AWMA IGP Team to compete at the FMBB World Championship. It is understood that if I am selected for and accept a team position and later withdraw from the team, the $250 good faith deposit will be forfeited.
Handler Signature *

Clear
Owner Signature *

Clear
Choose One *
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Good Faith Deposit - $250 - Pay Now Via Form $250 plus PayPal Fee $ 257.50

Good Faith Deposit - $250 - Pay Separately through PayPal via the “Friends and Family” option to awmatreasurer@gmail.com Free

Good Faith Deposit - $250 - Pay Separately by check. Mail check to Annie Wildmoser AWMA Treasurer PO Box 41256 Los Angeles CA 90041 Free

Total $ 0.00
Declaration is not complete until deposit has been received.
If you have trouble with the form or need additional information, email wcnecommittee@gmail.com
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IGP III Declaration Form for the 2021 FMBB World Championship