AMCA Working Weight Pull Dog
Certification Application Form
Owner’s name_____________________________ Phone:______________________
Address:___________________ City:_______________ State:_______ Zip:________
Location of Event:______________________________ Date:____________________
Event Managing Organization/Club:___________________________________________
Secretary’s Name and Address:______________________________________________
________________________________________________________________________
Dog’s Registered Name:_________________________ Registration #:___________
Dog’s Weight at Event:_____________________ Weight Class:__________________
Maximum Completed Pull (16 feet in allotted time):____________________________
Placing:_____________ Number of Dogs in Class:_________ (WDX Applicant Only)
Vehicle Used: Sled_______ Wheeled Rig_______ Other (please specify)_________
Type of Surface of Pulling Area:___________________________________________
Temperature:_________ Conditions:________________________________________
Were events run under ISDRA_____ AMCA_____ IWPA_____ Rules? (check one) If
no, have
rules been submitted to the committee for approval? If no, please include acopy of the rules. (Yes) (No) (Circle one)
|
To be completed by Event Official: |
I hereby certify that the above-named dog was entered in and did complete all events as listed on this form.
Name (please print):_____________________ Signature:_______________________
Date:____________ Title: Marshall______ Judge______ Timer______ Other_______
Address:______________ City:__________ State:_____ Zip:______ Phone:________
All necessary forms must be sent with application fee of $8.00 for the first dog and
$5.00 for
subsequent applications submitted at the same time to:for WD: Sue Fuller, 26 Malamute Road, Twisp, WA 98856
for WDX: Peggy Anderson, RR#1, Box 11, Locke, NY 13092
Form revised January 1986
For official use: Received: Date & Initial____________________