Application for Medallion (Club Title)

Application for Medallion (Club Title)

Please complete a separate form for each title if applying for more than one. If you wish you can print out the form for your own records, by clicking PRINT. Once you click SUBMIT the form, with attachments, will be emailed to Irene. If you have any issue uploading pictures of your score cards then PRINT out the form and EMAIL each application to Irene at francis7@bigpond.net.au, attaching all relevant qualification cards at that point. Passes achieved in open trials can be used towards a club title and included as part of this submission.
Name of Owner

First NameLast Name
Name of Dog
Breed of Dog
To find the required number of passes, check the title in the dropdown list below
Title applied for

Details of pass scores

Please note: All applications for the top level in each discipline (eg Masters in rally, agility etc and UDX in obedience) must only use the passes leading up to gaining the title – not any passes they get after they achieve such title
Upload images of your score cards

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