PVASC Fall Trial - Entry Form

Pleasant Valley American Schutzhund Fall Trial - November 7-8, 2026

Judge: Carla Griffith Helper: Jeremy Keller Trial Secretary: Steve Billimack
Name of handler

First NameLast Name
Name of dog
PSA Membership #
Dog Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex
Handler Owner Trained
Current Titles
Breed
Name of Club
AKC Reg #
Other Reg #
Tattoo/Microchip
Owner/Co-Owner
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Options
prevnext( X )
Title/Test Options
Title: $50.00

Please select the title the handler/dog team would like to participate in.

Payment Options:

Paypal:  @SteveBillimack

Venmo:  @Steve-Billimack

Zelle: (815) 404-7779

$100.00 Title



Total

$0.00
Any questions, please direct them to Steve (815) 404-7779 or sbillimack@gmail.com
Should be Empty:

Pleasant Valley American Schutzhund Fall Trial - November 7-8, 2026