Application for Medallion (Club Title)
Please complete a separate form for each title if applying for more than one. Please PRINT out and EMAIL each application to Irene at francis7@bigpond.net.au, attaching all relevant qualification cards. Passes achieved in open trials can be used towards a club title and included as part of this submission.
Name of Owner
First Name
Last Name
Name of Dog
Breed of Dog
To find the required number of passes, check the title in the dropdown list below
Please Select
CPD 3
OBD 3
OID 3
OAD 3
OADX 3
Club Rally Novice 3
Club Rally Advanced 3
Club Rally Excellent 5
Club Rally Masters 7
Title applied for
Please Select
CPD
OBD
OID
OAD
OADX
Club Rally Novice
Club Rally Advanced
Club Rally Excellent
Club Rally Masters
Details of pass scores
Club conducting event
Date
Judge
Points/Placing
1st Pass
2nd Pass
3rd pass
4th Pass
5th pass
6th Pass
7th Pass
Upload images of your score cards
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: