Heartland NAVHDA Test Entry Form
Please complete the following fields. Click Submit when finished.
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indicates required fields
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Chapter:
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Test Dates:
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Preferred Running Day:
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Check Type of Test:
Natural Ability
Utility Preparatory
Utility
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NAVHDA Dog Registration #:
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Sex:
Male
Female
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Age at Time of Test:
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Registered Name:
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Call Name:
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Whelp Date:
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Breed of Dog:
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Hip Dysplasia X-Rayed?:
Yes-Enclosed
Yes-On File
No
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Owner:
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Owner NAVHDA Member #:
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Street:
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City:
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State/Prov:
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Postal Code:
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Phone:
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Email:
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Handler:
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Handler NAVHDA Member #:
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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.
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