USA-BOX Event Authorization Request

USA-BOX Event Authorization Request
This document is to be submitted by the hosting club before an event will be authorized and must be received 6 months prior to the event date. Requests submitted after the six month window will be considered for approval on a case by case basis.
A copy of the Club's current Insurance Declaration Page must accompany this form.*

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Cancelof
Club Name*
Website Link For More Information*
Location of Show*

Name of Location

Street Address

CityState / Province

Postal / Zip Code
Event Date (Day 1)*

MonthDayYear
Date
Event Type (Day 1)*

Working TrialConformationZTPKoerungADOther
Event Date (Day 2)

MonthDayYear
Date
Event Type (Day 2)

Working TrialConformationZTPKoerungADOther
Event Date (Day 3)

MonthDayYear
Date
Event Type (Day 3)

Working TrialConformationZTPKoerungADOther
We Have already confirmed the availability of a Judge*

YesNo
Judge 1
Judge's Licensing Organization
AWDF, ATIBOX, Etc.
Judges Country of Residence
Judge 2
Judge's Licensing Organization
AWDF, ATIBOX, Etc.
Judges Country of Residence
Event Chair Information
Event Chair Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Event Secretary Information
Event Secretary Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Additional Committee Members (minimum 3 addl. members)*
I agree that this club has met and agrees to all requirements set forth by the Board of Directors of USA-BOX which are needed to hold this event. We now request formal, written authorization from USA-BOX to hold the aforementioned event.
Name of Officer submitting this form*

First NameLast Name
Officer Title*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Initials*
My Products
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Event Fee$50.00

Total $0.00
Should be Empty: