United State Police Canine Association
N.O.R.T. Canine/Judges Training
Hosted by the Middletown Police Department
1345 Runway Maintenance Road
Middletown, Ohio 45042
April 27-28, 2007
Registration Form
Name:
Address:
City/State/Zip: Phone:
Agency:
Agency Address:
City/State/Zip: Phone:
K9 Name: Age: Breed:
LODGING IS NOT INCLUDED
Registration Fee: ______(FREE) USPCA Region 5 Members
______$20.00 Outside USPCA
______$40.00 Non-member (Includes one year USPCA Membership)
Location: Middletown, Ohio Lodging: Manchester Inn
1027 Manchester Avenue
Middletown, Ohio 45042
Contact: Bill Hollister
Mail registration to: Region 5- N.O.R.T. Training
Attn: Bill Hollister
1335 Avalon Drive
Middletown, Ohio 45042
I here by waive and relinquish U.S.P.C.A., U.S.P.C.A. Region 5, the Middletown Police Department, The City of Middletown, and all other event organizers from any injury to myself or K9 while participating in this event. I also agree to abide by the rules established by the U.S.P.C.A while attending this event. My K9 is currently up to date on all required vaccinations. I accept responsibility for any damages caused by my K9, to the property or any other person while attending this event.
Signature: Date:
N.O.R.T. K9/JUDGES TRAINING
INVOICE
April 27-28, 2009U.S.P.C.A. Region 5 N.O.R.T. K9/Judges Training
Deadline April 20, 2009
U.S.P.C.A. Membership / FREE
Outside USPCA Member / $20.00
Outside Non-member (Includes one year USPCA Region 5 Membership) / $40.00
First Name: / Last Name:
Office Name: / Title:
Street Address:
City: / State: / Zip-Code:
Phone Number: / Fax Number:
Payment Check Number/Purchase Order Number:
TOTAL $
All applicants please fill out the below information and submit with payment.
K9 Name and AgeAgenda
April 27, 2009
Start time: 1200 hrs
Training for Judges only. No K9’s will be needed on this day.
This course if designed for current and future judges.
April 28, 2009
Start time: 0900 hrs
Training for Judges and K9s.
This course if designed for current and future judges.