2023 USCA Northwestern Regionals
September 8-10, 2023
Hosted by the Placer County Schutzhund Club
Judges: SV/USCA Nathaniel Roque - Obedience and Protection Judge, USCA Robert Johantgen - Tracking Judge
Deadline! August 25, 2023!
Registration closes at Midnight!
Handler Information
Handler Name
*
First Name
Last Name
Club Affiliation
USCA Region
Please Select
Northwestern
Pacific Northwest
Southwest
North Central
Mid Central
South Central
New England
North Eastern
South Eastern
Other
Email and confirm your email
*
Confirmation Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Handler Address
*
Handler Street Address *
Handler Street Address Line 2
Handler City *
Handler State / Province *
Handler Zip / Postal Code *
Handler USCA Membership Number
*
Handler Membership Expiration
*
-
Month
-
Day
Year
Date
Club and Date where BH earned
*
Dog Information
Registered Name of Dog
*
Call Name
Current Titles
*
Tattoo / Microchip Number:
*
Registration Organization
*
USCA
SV
AKC
Other
Registration Number
*
Scorebook Number
*
Breed
*
HOT (Hander Owned and Trained) or BHOT (Breeder, Handler Owned and Trained)?
*
HOT
BHOT
None of the above
Date of Birth
*
-
Month
-
Day
Year
Date
Sex
*
Male
Female
BHOT (Breeder, Handled Owned and Trained)?
Yes
No
HOT (Handled Owned and Trained)?
Yes
No
Catalog Photo
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Choose a file
JPG, PNG, GIF only. Please submit a photo for the catalog and website. If you are not ready to submit today, you will find a link on your confirmation email to submit later. PREFERRED image size square, 1048 x 1048. Your image may be cropped to fix on the website.
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Owner Information (only if different than Handler)
Owner Name (if different from handler)
First Name
Last Name
Owner Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner USCA Membership Number
Owner Membership Expiration
-
Month
-
Day
Year
Date
Release Statement
Release Statement
All dogs are to be under the control of the handlers/owners at all times. The handlers/owners are fully responsible for the actions of their dogs while on or near the trial grounds. Handlers/owners also waive all claims against United Schutzhund Clubs of America (USCA), Placer County Schutzhund Club (PCSC), its members, officers, directors, participants, and property owners, for any accident or injury or loss which may occur on or near the trial grounds, directly or indirectly, before, during, or after this event. Handlers/owners also further agree to abide by all rules of USCA and PCSC. Rules are posted at the USCA Northwestern Region website at: uscanwregion.com/championship-rules. My signature below indicates that I have read, understood, and accept these terms.
Photo Release
By submitting this form you are hereby granting permission to the Placer County Schutzhund Club, the USCA Northwest Region, the United Schutzhund Clubs of America or Brian Aghajani / Aghajani Photography to use photographs and/or video of you and/or your dog taken at the 2023 USCA Northwest Regional Championship in publications, news releases, online, and in other communications related to the mission of the USCA. Should you wish to opt out, please send an email with your name, your email address, and your dog's name to placerschutzhund@gmail.com.
Type your full name below to indicate you have read and understood and agreed with this form:
*
Payment
Payment
You will be directed to PayPal where you can use your credit card or PayPal account to pay for your entry. A PayPal account is NOT required as you will have a choice to pay by credit card. ENTRY FEES ARE NON-REFUNDABLE. Should you need an alternate payment method, please contact placerschutzhund@gmail.com for a manual entry form.
Entry and Event Fees
*
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IGP 3 Entry
Registration fees are non-refundable
$
160.00
IGP 2 Entry
Registration fees are non-refundable
$
160.00
IGP 1 Entry
Registration fees are non-refundable
$
160.00
Guest for Draw Night Dinner
Draw Night Dinner for competitors is included in your registration fee. If you wish to bring guests, you can prepay for them now at $20 per guest. Tickets at the door will be $25.
$
20.00
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