Print, fill out and mail or fax to:
Wm Penn Poodle Club Futurity, c/o Betty Kelley, 107 Karrs Lane, Conshohocken, PA 19428
Or e-mail all info to Arabesque19428@aol.com
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OFFICIAL ENTRY BLANK
WILLIAM PENN POODLE CLUB FUTURITY
Carol C. Dewey, Founder

Futurity Litter#_________________________
Official Use Only_________________________

Check one: October, 2005____
POSTMARK WILL DETERMINE DATE OF ENTRY (EXCEPT FOR FINAL ENTRY
MAKE CHECKS AND MONEY ORDERS payable to the William Penn Poodle Club Futurity.
ENTRY FEES must be paid in Net U.S. dollars. Canadian Exhibitors: Add $.65 per check written.
MAIL ENTRIES WITH FEES TO: William Penn Poodle Club Futurity, c/o Betty Kelley, 107 Karrs Lane, Conshohocken, PA 19428
PLEASE DO NOT SEND CASH


Step One
DATE OF BREEDING________________
BITCH NOMINATION FEE $6.00 when
entered prior to the date of whelping.
ENTRY FEE ENCLOSED$_____________
PENALTY FEE $5.00 in addition to the regular fee
for each month (or fraction) if entered after bitch
has whelped.
PENALTY FEE ENCLOSED$___________
FUTURITY LITTER NUMBER must accompany
all futurity entries once have been assigned.


For Kindergarten Class (3 to 6 Months)

Complete All Items
Except 2, 3, 5, and 6.
STEP TWO
PUPPY ENTRY
DATE OF BIRTH________________
PUPPY NOMINATION FEE $3.00 for entry of
each puppy from previously qualified litters when
entered prior to three months of age.
ENTRY FEE ENCLOSED $_______________

PENALTY FEE $5.00 in addition for each month
(or fraction) if entered after three months of age.
PENALTY FEE ENCLOSED $____________________,

FUTURITY LITTER NUMBER_____________________,

Complete all items 1-19
STEP THREE
FINAL ENTRY ENTRIES CLOSE 6 pm, Sept 26, 2003
after which time entries positively will NOT be accepted.
PUPPY FINAL ENTRY FEE $3.00 for each puppy
previously nominated for the Futurity.
STUD DOG CLASS FEE $3.00
BROOD BITCH CLASS $3.00
RETURN WINNERS CLASS $3.00

Seperate entry blanks are required for each class
and entry.

FINAL FEE ENCLOSED $____________________

FUTURITY LITTER NUMBER___________________

Complete all items 1-19


INDIVIDUAL ENTRY FORMS MUST BE FILLED OUT FOR EACH AND EVERY PUPPY ENTRY, signed at the bottom by the owner or by the owner's duly authorized agent, and accompanied by the required fee, otherwise entry cannot be accepted. PLEASE TYPE OR PRINT CLEARLY. All puppy and bitch nominations are good for one year only. Each Futurity is a seperate event.

(1)Variety of Entry__________________________________(2)Date of Birth_____________________(3)Sex of Entry_________________
(4)Full Name of Owner_____________________________________________________________________________________________________________________________________
(5)Full Name of
Entry_____________________________________________________________________________________________________________________________________

(6)Color________________If final entry, check one of the following: (Puppy_____) (Young Adult_____) (Stud Dog_____) (Brood Bitch_____)

(7)Breeder of Litter____________________________________________________________________________________________________________________________________

(8)Sire of Litter_________________________________________________________(9)AKC Reg.#______________________(10)Color________________

11)Dam of Litter_______________________________________________________(12)AKC Reg.#______________________(13)Color________________
(14)Owner's Street
Address_____________________________________________________________________________________(15)Phone#_______________________________________

(16)City__________________________________________________________(17)State________________________(18)Zip Code____________________
(DO NOT ABBREVIATE) I CERTIFY that I am the actual owner of this bitch or dog being qualified, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of the American Kennel Club in effect at the time of this Futurity, and by any additional rules and regulations appearing in the premium list for this Futurity, and further agree to be bound by the "Agreement" printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the foregoing representation and agreement. (19)SIGNATURE of owner or his agent duly authorized to make this entry.

X____________________________________________________________________________

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