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

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

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____________________