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:
  *NAVHDA Dog Registration #:
  *Sex:
  *Age at Time of Test:
  *Registered Name:
  *Call Name:
  *Whelp Date:
  *Breed of Dog:
  *Hip Dysplasia X-Rayed?:
  *Owner:
  *Owner NAVHDA Member #:
  *Street:
  *City:
  *State/Prov:
  *Postal Code:
  *Phone:
  *Email:
  *Handler:
  *Handler NAVHDA Member #:
  *Phone:
  *Email:
  *PayPal Amount sent:

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 for entry confirmation. Payment via PayPal MUST be made directly after your data transfer.
 
 
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