MODULO DI ISCRIZIONE

MODULO DI ISCRIZIONE
Raduno sezionale
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organizzato dalla Sezione: _______________
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Regione: _________________________________________________________
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Data: __
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Località ______________________________________________________
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Allievo giudice signor: _____________________________
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Nome del cane _________________________________
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Maschio
Classe:
Baby
Femmina
Juniores
Nato il : __________
pelo normale
Cuccioloni
Giovanissimi
Giovani
pelo lungo con sottopelo
Libera
Lavoro
Veterani
R.O.I.: _______________ S.Z.:
S.Z.: _______________
Microchip: __________________ Tat. _______________
(minimo 15 numeri)
HD:
HD
A
B
C
ED:
ED
0
BL
1
IPO:
Selezione: SI NO
IPO _____________________ Selezione
----------------------------------------------------------------------------------------------------------------------------------------------------------------Padre:
Padre ____________________________________________________________
HD:
HD
A
B
C
ED:
ED
0
BL
1
IPO:
Selezione:
IPO _____________________ Selezione
SI
NO
Madre:
Madre ____________________________________________________________
HD:
HD
A
B
C
ED:
ED
0
BL
IPO:
Selezione:
IPO _____________________ Selezione
1
SI
NO
----------------------------------------------------------------------------------------------------------------------------------------------------------------Allevatore: _______
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_ Tessera S.A.S. __________/______
Proprietario: ________________________________
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Indirizzo: _______________________________________
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_______________________________________ CAP ________ Citta’ __________
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Conduttore: ____________________________________
____________________________________ Tess. S.A.S. _______
__________/
_____/______
___/______ tel. ________________
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Con la firma della presente si conferma di essere a conoscenza dei Regolamenti sociali validi per la manifestazione.
Il Proprietario Firma leggibile: _______________________________________
27-02-2013
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RELAZIONE D’INSIEME
(spazio riservato all’Allievo giudice)
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Classifica ________________ Qualifica _____________
Firma dell’allievo giudice: __________________________________________________
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