ENTRY FORM (for one dog)
Block writing or with type machine before 12-06-2012
Name of the dog
……………………………………………………………………………………
N° LOSH…………………… NHSB………………………LOF……………………….. LOL………………..
ander stamboeknr. /N° d’un autre livre d’origine / Registry nr. of another studbook …………………...........
reu/mâle/male □ teef/femelle/female □
Geboortedatum / Date de naissance/ Date of birth…………………………
Vader / Père / Father :………………………………………………………………..
Moeder / Mère / Mother :……………………………………………………………………..
Fokker / Éleveur / Breeder:…………………………………………………………
OWNER ……………………………………………………………………………………………….
Straat / Rue / Street …………………………………………………………………………N°………………….
Postcode / Code Postal / Postal code…………………………
Woonplaats / Domicile / Place-City ………………………………………… Land / Pays / Country……………………
Tel./Tél. ………………………………………………..e-mail……………………………………………………………………………………
1. o BABY 3 à6 m.
o Brace * met/avec/with
2. o PUPPY 6 à9 m.
3. o JEUGD/JEUNES/JUNIOR 9 à18 m ……………………………………………..
4. o INTERMEDIAIRE 15 à24 m o Group ** with ........................................
5. o OPEN-OUVERTE +15 m
…………………………………………..
6. o FOKKERS-ÉLEVAGE-BREEDER +15 m
(For dogs, from 15 months, showed by the breeder)
7. o VETERANEN-VÉTÉRANS + 8 years
8. o KAMPIOEN-CHAMPION ( add certificate)
* KOPPEL/COUPLE/BRACE :2 dogs, one male and one female, owned by the same exhibitor and entered in an individual class.
** GROEP/GROUP(E) : at least 3 dogs, owned by the same exhibitior and entered in an individual class.
The undersigned declares not to be a member of a club not affiliated to the FCI and to comply with the KKUSH/URCSH and the FCI regulations. By returning this form the exhibitor commits himself to pay the fee, even if he does not attend the Show.
.....................……………………, de/le/date ………………………………………………………………….2012
HANDTEKENING / SIGNATURE …………………………………………………………………………