WC Test Online Entry Form


INSTRUCTIONS:
1. Complete the Working Certificate Entry form below
2. Type in the information EXACTLY as it should appear in the catalogue
3. ALL fields marked * ARE REQUIRED
4. Click the Submit button to send in your data
5. You will be re-directed to the GRCGT Online Store where you can pay for your entry
6. Want to enter more than one dog? Return to this page, add the new dog, click Submit
7. When you are re-directed to the GRCGT Online Store, you can pay for multiple dogs
8. Fees for online submission are included in the prices shown below

PLEASE NOTE: Your electronic form acceptance is not finalized until we receive your payment. Online submissions will be CANCELLED if your online payment is not received.

ENTRIES CLOSE MONDAY, AUGUST 4, 2014 AT 8:00 PM

GRCGT WORKING CERTIFICATE TESTS

AUGUST 7, 2014
Puslinch, Ontario



Working Certificate Test + Online Fee:*
WC ($51.50 CAD)
WCI ($51.50 CAD)
WCX ($62.00 CAD) 		WC

WCI

WCX
CKC Listing + Online Fee:*
$9.60 CAD (includes HST) 		Add

Not applicable
Breed:* Chesapeake Bay Retriever

Curly-Coated Retriever

Golden Retriever

Flat-Coated Retriever

Irish Water Spaniel

Labrador Retriever

Nova Scotia Duck Tolling Retriever

Poodle
Sex (M/F):*
Registered Name of Dog:*
CKC Registration#:*
AKC Registration#:
Event Registration#:
Tattoo/Microchip:
Date of Birth (dd/mm/yyyy):*
Country of Birth:*
Breeder(s):*
Sire's Registered Name:*
Dam's Registered Name:*
Registered Owner(s):*
Owner's CKC Membership#:
Owner's Street Address:*
Owner's City:*
Owner's Province:*
Owner's Postal Code:*
Handler's Name:*
Owner/Handler's Phone#:
Owner/Handler's Email Address:*
e-Signature (selecting Yes indicates
you certify that you are the registered
owner/agent of this dog and accept full
responsibility for the accuracy of all
information on this form. In addition,
you agree to immediately pay the
required fees electronically):* 		Yes

No