Organizer’s Use

Paid __________

No. Days ______

IWPA ENTRY FORM

Date____________________________________           Entry Fee $___________________________
Name of Event_____________________________________________________________________
Name___________________________________________ Phone____________________________
Address__________________________________City_____________St/Prov/Zip________________
Email Address ____________________________________ Number of dogs entered_____________
Are you an IWPA member?_______________ Date joined this season__________________________

Handler Agreement: I acknowledge and agree to be responsible for my conduct and the conduct of my dog(s), and my family. Further, I shall not hold the sponsor of the club or the organizing club liable for any injury or damage to myself, my dogs, or my equipment. I state this dog(s) is not on any kind of medication not stated to the Chief Judge and is in fine medical health and is up to date on all vaccinations. I state this dog(s) is at least one year of age but not more than twelve years in age. I agree to follow IWPA rules. I also consent to unannounced drug testing of any or all dogs entered in this contest.

Signature____________________________________________Date______________________
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Dog’s Name			Wt		Breed		Sex	Weight		Years
									Pulled		Pulling
0-20 lbs Class
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21-40 lbs Class
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41-60 lbs Class
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61-80 lbs Class
________________________________________________________________________________________
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81-100 lbs Class
________________________________________________________________________________________
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101-125 lbs Class
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126-150 lbs Class
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151& Over (Unlimited) Class
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revised 06/07 dmd