NACSW™ ORTs Registration Form

Saturday, September 14, 2024

Clear Lake Grange, 1510 Big Valley Road, Lakeport, CA 95453

Registration Fee: $35 per odor payable by PayPal

Questions: Contact Alison Herrold at info@FrontandScenterDogTraining.com

Odor(s):*

BirchAniseClove

Dog's Call Name*

Breed(s)*

Dog's NACSW #*

Handler's Name*

Handler's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Handler's NACSW Membership #*

Phone number where you can easily be reached*

Please enter a valid phone number.

Handler's email address*

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.

An ORT must be taken and passed at least 14 days before a trial opening date to be eligible for the first draw period.

Please contact your host at least one day before the ORT if your female dog will be in season.

All confirmations will be sent via email within seven (7) days of receipt of complete registration form and payment.

I/we hereby assume all risks of, and responsibility for, accidents and/or damage to myself or to my property or to others resulting from the actions of my dog. I/we expressly agree that Alison Herrold; Clear Lake Grange #680, 1510 Big Valley Road, Lakeport, CA 95453; and/or any other person, or persons, of said groups, shall not be held liable personally or collectively under any circumstances for injury and/or damage to my person, for loss or injury to my property, whether due to uncontrolled dogs or negligence of any member of said groups, or any other cause or causes.

Signature*