Heartland NAVHDA Test Entry Form
Please complete the following fields. Click Submit when finished.
*
indicates required fields
*
Chapter:
*
Test Dates:
*
Preferred Running Day:
*
Check Type of Test:
Natural Ability
Utility Preparatory
Utility
*
NAVHDA Dog Registration #:
*
Sex:
Male
Female
*
Age at Time of Test:
*
Registered Name:
*
Call Name:
*
Whelp Date:
*
Breed of Dog:
*
Hip Dysplasia X-Rayed?:
Yes-Enclosed
Yes-On File
No
*
Owner:
*
Owner NAVHDA Member #:
*
Street:
*
City:
*
State/Prov:
*
Postal Code:
*
Phone:
*
Email:
*
Handler:
*
Handler NAVHDA Member #:
*
Phone:
*
Email:
*
PayPal Amount sent:
NA - $100 US
UPT - $125 US
UT - $125 US
Your entry has not been sent until you click on Submit. Once your payment is received by PayPal (account # HeartlandNAVHDA@AOL.com), you will be contacted at the email address you've provided above.
Site Map
