Taking the Mystery out of the Box-with Ana Cilursu Registration & Payment Form
SUNDAY JULY 14, 2024 9AM -4PM
Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Name of Dog (for working spots only)
At what level is your dog working? (ie.No experience, AKC Novice, NACSW NW3) -For working spots only
Emergency Contact
First Name
Last Name
Emergency Contact Cell Phone
Please enter a valid phone number.
Choose ONE Option: (No refunds for your working spot unless it can be filled from the waitlist)
*
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next
( X )
WAITLIST-WORKING SPOT
WORKING SPOTS WILL BE FILLED FROM THE WAITLIST IN ORDER RECEIVED
$
Free
AUDITING SPOT-MEMBER IN GOOD STANDING
LUNCH INCLUDED. DO NOT BRING YOUR DOG
$
50.00
AUDITING SPOT-NON-MEMBER & OTHER MEMBERS
LUNCH INCLUDED. DO NOT BRING YOUR DOG
$
60.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: