Print this form and mail or fax with payment to address below
Lion Country Supply Bird Dog Challenge
Division: (check one only)
Single Pointing______ Single Flushing______
(Each dog may run a maximum of two times per division. i.e. two single runs and two
team runs)
Preferred Time (check any or all) AM_____ PM_____
Run Times will be assigned in order entries are received. We will contact you only if
your preferred
time is not available.
| Entry Fees: $70 Single Divisions Option Pool Entry (pays 50% - 30% - 20% in class) $10.00 Total for this run. |
$______ $______ $______ |
Handler:
Name______________________________________________________________
Address_________________________________________________________________________
City_____________________________________________State_____________ Zip____________
Phone (Day)_(____)_____________ (Evening)_(____)______________e-mail__________________
Dog: Name________________________________________________________
Breed_____________________________________________________________
Birth Date____________________________________(You must provide proof for puppy divisions)
Titles or Accomplishments __________________________________________________________
______________________________________________________________________________
TOTALS FOR ALL ENTRIES (Fill out one only for entire event)
| ----# of Single Entries: Pointing Breeds _____ Flushing Breeds _____ @$70 per run Options _____ @$10 per run Total Entry Fees: |
$______ $______ $______ |
PAYMENT METHOD: CHECK___ VISA___ MC___ AMEX___ Discover___
Card #___________________________Exp. Date ______Signature______________________
WARRIORS MARK WINGSHOOTING LODGE, 548 Hunt Club Dr.,
Ginter, PA 16651
(814) 378-8380 Fax: (814) 378-8381 www.warriorsmark.com