Name *

First Name

Last Name

Phone

(###)

###

####

What award are you applying for?

Field Dog

Field Dog of the Year

Field Dog Hall of Fame

Capitaine Fracasse Challenge

Korthals Vision

Date of Birth *

MM

DD

YYYY

Please check all awards that dog has earned

Points earned in parentheses

Junior Hunter (1)

JH Advanced

Senior Hunter (4)

SH Advanced

Master Hunter (6)

MH Advanced

NA I (2)

NA II (1)

NA III (1)

UPT I (3)

UPT II (3)

UPT III (3)

UT I (6)

UT II (5)

UT III (5)

VC (10)

AKC Field Champion (8)

AKC Amateur Field Champion (7)

AKC Griff Only Field Champion (6)

AKC Griff Only Amateur Field Champion (6)

AKC JH Retriever (2)

AKC SH Retriever (3)

AKC MH Retreiver (5)

For Korthals Vision Only:

AKC Champion

AKC Grand Champion