Klik hier voor het Nederlandse formulier.
Closure date
10-05-2017

CAC awarded by the Raad van Beheer.

4th Championship Clubmatch Lagotto Romagnolo Club Nederland

25 may 2017 - Location: KC Uden, The Netherlands - Judge: mrs. F. L. Mensink (NL).

Entry Form
Breed: Lagotto Romagnolo Sex:
 

Name of the dog:
Titles of the dog:

Pedigree Nr.:
Date of Birth: (dd-mm-yyyy)
Class:

** Copy of the declaration from ruling organisation or copy championship must be send to the KCM administration. See the adresses down on this page.
If there is not a declaration present by the administration, the dog will be entered in open class.
This is only needed for class 6 or 7.


Breeder:
Sire:
Dam:

Owner
First name(s):
Family name(s):
Co-Owner
First name(s):
Family name(s):

Address:
Code and City:     

Country:
Tel:    E-MAIL:   
   
Forwarding address:
** In case of a forwarding address the person at this address is co-responsible for the payment of the entry.
 
The dog is legally docked at the tail:
The dog’s tail is amputated for medical reasons:

If yes please bring veterinary declaration in the European passport)

Entry fee
 
Entry and payment before: 10-05-2017
 
Classes 3 to 9
(incl. 1 catalogue)
X € 42.50
2nd dog: X € 37.50
3rd and additional dogs X € 32.50
Baby & Puppy class X € 32.50
Brace class (per brace): X € 5,00
Breeders class (per group): X € 5,00
Progeny class (per Group): X € 5,00
Junior handling
(Only possible by age from 5 till 15 years)
X € 5,00

Name person junior handling:
Age of person junior handling:
 

Owner is member of the LRCN?   
Each member gets €5,= discount per dog.
membership discount: 0.00

-------------
Total: 0.00



This amount must be paid at the same time the entry form is sent.

 

Payment


Accountnbr.:4224679
Iban nr: NL96INGB0004224679
Bic: INGBNL2A
In name of: L.R.C.N. te Tiel
(Bank) cheques and international money orders will not be accepted.

This Entry form will be sent to:


KCM Secretariaat Lagotto Romagnolo Club Nederland
Astrid Straaijer
Kuilstraat 16
6612AX Nedersasselt
The Netherlands
 
astrid@lagotto.nl
 


The show regulations, the rules of the Raad van Beheer op Kynologisch Gebied in Nederland and the FCI are in force. These rules are to be considered as part of this entry form. By sending in this form you state to know and accept those rules. Sending in the form is considered the same as your signature.

 
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