Chapter Club Medallion Order

Please fill out an order for EACH of your show dates.

Name of Chapter Club*

Club's Show Initials to be Engraved*

Do you want a show date to be engraved on the medallion?*

YesNo

Club's Show Date to be Engraved

MonthDayYear

Medallion to be shipped to:*

First NameLast Name

Address to be shipped to:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your email:*

example@example.com

Your phone:*

Please enter a valid phone number.

Medallions ordered*

Best of Breed (Silver Tone)

$ Free Quantity

High in Trial obedience (Silver Tone)

$ Free Quantity

High in Trial Agility (Silver Tone)

$ Free Quantity

Judge (Bronze Tone)

$30 Quantity

Obedience Judge (Bronze Tone)

$30 Quantity

Sweeps Judge (Bronze Tone)

$30 Quantity

Best Junior Handler (Bronze Tone)

$ Free Quantity

Total

$0.00

Payment Method
Credit	Express