Afghan Hound Club Of America

ALL-BREED AKC LICENSED LURE COURSING TRIALS AND TESTS

All AKC Recognized Sighthound Breeds

SATURDAY, February 6, 2016 SUNDAY, February 7, 2016

PARK’S RESIDENCE 1636 Airline Goldmine Road

Canon, GA 30502

Permission has been granted by the American Kennel Club for the holding of this event under American Kennel Club rules and guidelines. AKC Events #2016169318 & 2016169319

PRE-TRIAL ENTRY FEES: $18.00 for the first hound entered $12.00 for second hound, same household/owner

$10.00 for third hound (or more), same household/owner JC and QC TEST ENTRY FEES: $20.00 per hound

DAY OF TRIAL ENTRY FEES: $30.00 all hounds entered, including JC/QC

Test/Trial Hours 8:00 a.m. UNTIL COMPLETE

PREMIUM LIST

PRE-TRIAL ENTRIES MUST BE RECEIVED BY WEDNESDAY 6:00pm February 3, 2016 at the Trial Secretary’s address

DAY OF TRIAL ENTRIES CLOSE AT 8:30 AM at the Trial Site Field Secretary Table

Afghan Hound Club Of America President: James Hick Vice President: Tony Saia Secretary: Dorma Sue Busby Treasurer: Linda Jackson.

FIELD COMMITTEE

Field Chairman: Max Ross, Jacksonville, FL Field Secretary: Larry Richards, 8223 Lantana Dr, Denver NC 28037

Home 704-483-6269, Cell 704-400-9291, Email TnTsKids@aol.com Field Committee: Max Ross, Larry Richards, Donna Richards, Kasey Parks, Dale Parks

JUDGES Kirby Overcash Maiden, North Carolina Kasey Parks Canon, Georgia Donna Richards Denver, North Carolina

ASSIGNMENTS

JC and QC Judging Kasey Parks —Saturday / Kirby Overcasj—Sunday

TEST/TRIAL HOURS Trial Hours: 8:00 A.M. until complete. Day of Trial Entries close at 8:15 AM!!

JC and QC Roll Call: 8:30 A.M. roll call followed by test until complete

Trial Roll Call: 8:45 A.M. ALL BREEDS Earlier Roll Call for Field Committee, followed by draw.

You will be expected to have complete information on your hound!! Incomplete entries WILL NOT BE ACCEPTED!

If a hound passes the required QC Test and the owner/handler wishes to enter the subsequent trial, the AKC Coursing Director has granted this club permission to accept trial entries following

the test. Entries in this case will be accepted for a period of 15 minutes immediately following the announced finish of the QC Test.

ENTRIES WILL NOT BE ACKNOWLEDGED BY MAIL

ALL OWNERS MUST PICK UP AFTER THEIR HOUNDS! DO NOT DRIVE ACROSS THE FIELD.

DO NOT LEAVE YOUR TRASH/POOP ON THE PROPERTY Trash Services are not offered.

Trial Ribbons: 1st– Blue, 2nd-Red, 3rd-Yellow, 4th-White, 5th-Pink, BOB-Purple and Gold, BIF-Red/White/Blue. Qualifying Test-Dark Green . Trophies donated by AHCOA.

Neither The Afghan Hound Club of America, nor its members will be Responsible for any accidents at this trial.

SAT Af Ba B G IB IW IG P RR S SD W Singles FSSB

Kirby X X X X X X X X X X X X X

Kasey X

SUN Af Ba B G IB IW IG P RR S SD W Singles FSSB

Kirby X X X X X X X X X X X X X

Donna X X X X X X X X X X X X X

Kasey X

QUALIFIED COURSER CERTIFICATE Instructions: This form is to be used when a hound successfully completes the Qualified Courser Test at an AKC® Lure Coursing event. A hound must have received this certification within one year of the closing date of the trial being entered to be eligible to compete in an AKC Lure Coursing Trial in the Open or Open Veteran stake. This form must be properly completed and submitted along with this hound’s first entry in an AKC Lure Coursing Trial in either stake. * Hounds who have earned a Field Championship from either the American Sighthound Field Association (ASFA) or the Canadian Kennel Club (CKC) are exempt from this requirement. A copy of the applicable FC certificate must accompany the first entry of these hounds. To be completed by owner/agent: Breed_____________________________________________________ AKC Registered Name ________________________________________________ AKC Registration Number __________________________________ I hereby certify that the hound running in the Qualifying Course is the hound identified above and the information provided is true and correct.

Printed Name of Owner/Agent ________________________________ Signature of Owner/Agent _________________________ Date ___________

___________________________________________________________ To be completed by certifying judge:

I hereby certify that the above referenced hound passed the Qualified Courser Test by running clean with another hound of the same breed or one with a similar running style completing a course a minimum of 600 yards. Judge’s Printed Name _________________________ Judge’s Number __________ Judge’s Signature _______________________________ Date______________

QUALIFIED COURSER CERTIFICATE Instructions: This form is to be used when a hound successfully completes the Qualified Courser Test at an AKC® Lure Coursing event. A hound must have received this certification within one year of the closing date of the trial being entered to be eligible to compete in an AKC Lure Coursing Trial in the Open or Open Veteran stake. This form must be properly completed and submitted along with this hound’s first entry in an AKC Lure Coursing Trial in either stake. * Hounds who have earned a Field Championship from either the American Sighthound Field Association (ASFA) or the Canadian Kennel Club (CKC) are exempt from this requirement. A copy of the applicable FC certificate must accompany the first entry of these hounds. To be completed by owner/agent: Breed_____________________________________________________ AKC Registered Name ________________________________________________ AKC Registration Number __________________________________ I hereby certify that the hound running in the Qualifying Course is the hound identified above and the information provided is true and correct.

Printed Name of Owner/Agent ________________________________ Signature of Owner/Agent __________________________ Date ___________

___________________________________________________________ To be completed by certifying judge:

I hereby certify that the above referenced hound passed the Qualified Courser Test by running clean with another hound of the same breed or one with a similar running style completing a course a minimum of 600 yards. Judge’s Printed Name _________________________ Judge’s Number __________ Judge’s Signature _______________________________ Date______________

ELIGIBLE BREEDS AND REGISTRY Afghan Hounds, Basenjis, Borzois, Greyhounds, Ibizan Hounds, Irish Wolfhounds, Italian Greyhounds, Pharaoh Hounds, Rhodesian Ridgebacks, Salukis, Scottish Deerhounds, and Whippets that are one year of age or older, that have been registered with The American Kennel Club, or part of an AKC registered litter, or otherwise, if whelped outside of the United States of America and owned by a resident of the USA, or of a country with a foreign registry organization whose pedigrees are acceptable for AKC registration and is registered with that registry, or that have been granted an Indefinite Listing Privilege (ILP) or Purebred Alternative Listing (PAL), are eligible to participate in lure coursing tests and trials and be awarded the prefix title of Field Champion and the suffix titles of Junior Courser, Qualified Courser, Senior Courser or Master Courser. Those sighthounds enrolled in AKC’s FSS (Azawakhs, Cirneco, Norrbottenspets, Peruvian Inca Orchid, Portugese Podengos (Medino and Grande), Sloughis, Thai Ridgebacks) which are eligible to compete in Conformation Miscellaneous class are eligible to compete in lure coursing tests and trials and be awarded the suffix titles of Junior Courser, Qualified Courser, Senior Courser of Master Courser only. Spayed or neutered hounds are eligible to participate. Monorchid and cryptorchid hounds are ineligible to participate. Hounds may not be entered as “registration or ILP pending.” Breed disqualifications apply.

Italian Greyhounds and FSS breeds are not eligible to compete for Best In Field.

STAKES OFFERED AKC JC and QC Tests—Offered both days The JUNIOR COURSER TEST is open to all sighthounds of an eligible breed at least 1 year of age. A hound running alone shall receive a certification from a judge on one date and a second certification from a different judge at a later date, stating the hound completed at least a 600 yard course with a minimum of four turns. The hound must complete the course with enthusiasm and without interruption. The QUALIFIED COURSER TEST is open to all sighthounds of an eligible breed at least 1 year of age. The hound (Qualifying Hound) running with another hound of the same breed—or another breed with a similar running style—(Testing Hound) shall receive certification from a licensed judge. The hound must complete the course with enthusiasm and without interruption, sufficiently course the lure and not course the Testing Hound. The judge will certify that the Qualifying Hound ran cleanly and did not appear to present a hazard to the Testing Hound at any point in the qualifying course. This certificate is required to enter a hound in an Open Stake. The handler presenting the Qualifying Hound shall be responsible for providing the Testing Hound for the qualifying course. Upon successful completion of the Qualified Courser test, the judge completes a certificate and awards it to the handler. This certificate must be submitted to the host club with the hound’s first entry in an Open Stake. The certificate must be included when the results of the trial are sent to the AKC. AKC TRIAL STAKES OPEN: Open to all sighthounds of an eligible breed that have attained at least one of the following: AKC Qualified Courser Title, ASFA FCh Title, CKC Field Champion Title. Championship points may be awarded from this stake. Hounds who have earned an AKC Field Championship are not eligible to enter Open. OPEN VETERAN: Open to all hounds eligible to enter either Open or Special Stake and are of Veteran age as determined by their Parent Breed Club. Championship or LCX points may be awarded from this stake. SPECIAL: Open to all hounds that are eligible to enter Open Stake and have earned their AKC Field Championship Title. LCX points may be awarded from this stake. Hounds under disqualification from AKC, ASFA or CKC Field Trials may NOT be entered. SINGLES: Will be offered. Open to all sighthound breeds approved to participate in AKC Lure Coursing trials. Hounds with breed disqualifications are eligible to enter.

BEST IN FIELD (BIF) will be offered both days.

Italian Greyhounds are not eligible to compete for BIF.

PRACTICE

Will be held after the Trial is completed, Saturday only after any ASFA certifications, if weather, equipment and daylight permit. Practice is $3 per dog. Priority will be

given to sighthound breeds, but all are welcome. Practice will NOT be offered on Sunday.

Please pick up after your hounds!

CONDITIONS OF ENTRY

Hounds must be one year of age or older on the day of the trial. All hounds will run twice, in trios if possible or braces unless excused, dismissed or disqualified. Hounds not present at the time of roll call will be scratched after a 5 minute grace period. Bitches in season and lame hounds will be excused (with entry refunded). All hounds will be examined at inspection for breed disqualifications. Spayed or neutered hounds, without breed disqualifications may be entered. Battery powered, continuous loop lure machines will be used. The lure will consist of plastic strips. Only the Lure Operator, Huntmaster, Judges and Handlers of the hounds running in the course in progress will be permitted near the lure machine. The members of Carolina Lure Coursing Society reserve the right to alter the course plan as required by weather and/or field conditions on the day of the trial. The field will be reversed for the finals, runoffs, Best of Breed and Best In Field. Any person may, upon reasonable complaint, may be asked to leave the grounds of the field trial by the Field Committee and may be disciplined by the AKC. Children must be under control of their Parent(s) or Guardians(s) at all times. A $5.00 fine will be assessed on the owner or handler of any hound loose on the field but not competing in the course in progress. FIRST TIME OPEN STAKE ENTRIES using ASFA or CKC Field Champion Waiver must submit a copy of the Championship certificate along with entry. It is highly recommended the Qualified Courser hounds entering the open stake for the first time have successful practice experience both alone and with other hounds before competing in the Open Stake.

ON-CALL VETERINARIAN Royston Animal Hospital—2888 W. Main Street, Royston GA 20662 706-245-6650

EMERGENCY MEDICAL

Cannon EMT, Cannon Local Fire Dept., Cannon City Police Dial 911

CAMPING

Allowed on the field. RV’s are to park at the entrance at the top of the hill under the pecan trees. DO NOT DRIVE ACROSS FIELD. DO NOT LEAVE YOUR TRASH AND DOG(S) POOP ON THE PROPERTY Trash services ARE NOT OFFERED.

Please PICK UP after your dog!!!!!

Club: AHCOA

Date:

Location: Event type Test Trial

Class: JC QC Open Special Veteran Singles

Breed:

I Enclose Entry fees in the amount of : $

Breeder:

Registration No: Sex: Date of Birth:

AKC No. AKC Litter No. ILP No. Foreign No. & list country Full Name of Dog:

Call Name:

Sire: Dam: Actual Owner(s): Owner’s Address: City: State: Zip: Name of Owner’s Agent/Handler (if any at Trial:)

Please Separate My Hounds Check if hound has been dismissed within the last 6 trials entered. Must be marked in order to qualify for a “clean” trial requirement.

AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org AGREEMENT

I CERTIFY that I am the actual owner of this dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry. I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this trial, and by any additional rules and regulations appearing in the premium list for this trial, and entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. The entry is submitted for acceptance on the foregoing representation and Agreement. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prize money, ribbons, or trophies, I (we) agree to hold the AKC, the event giving club, their members, directors, governors, officers, agents superintendents or event secretary and the owner or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless form any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting there from, sustained by any person or persons, including myself (ourselves) or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.

Signature of Owner or his Agent duly authorized to make the entry:

Telephone:

E-mail Address:

Call Name _________________________________

OFFICIAL AMERICAN KENNEL CLUB LURE COURSING ENTRY FORM

Club: AHCOA

Date:

Location: Event type Test Trial

Class: JC QC Open Special Veteran Singles

Breed:

I Enclose Entry fees in the amount of : $

Breeder:

Registration No: Sex: Date of Birth:

AKC No. AKC Litter No. ILP No. Foreign No. & list country Full Name of Dog:

Call Name:

Sire: Dam: Actual Owner(s): Owner’s Address: City: State: Zip: Name of Owner’s Agent/Handler (if any at Trial:)

Please Separate My Hounds Check if hound has been dismissed within the last 6 trials entered. Must be marked in order to qualify for a “clean” trial requirement.

AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org AGREEMENT

I CERTIFY that I am the actual owner of this dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry. I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this trial, and by any additional rules and regulations appearing in the premium list for this trial, and entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. The entry is submitted for acceptance on the foregoing representation and Agreement. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prize money, ribbons, or trophies, I (we) agree to hold the AKC, the event giving club, their members, directors, governors, officers, agents superintendents or event secretary and the owner or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless form any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting there from, sustained by any person or persons, including myself (ourselves) or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.

Signature of Owner or his Agent duly authorized to make the entry:

Telephone:

E-mail Address:

Call Name _________________________________

OFFICIAL AMERICAN KENNEL CLUB LURE COURSING ENTRY FORM

Directions to the Field

GPS Address: 1636 Airline Goldmine Rd., Canon, GA 30520 From South Carolina: Interstate 85 Exit 177 Elberton/Hartwell turn left off ramp onto GA 77 South for approximately 7 miles (just past Cross Roads Baptist Church) turn right onto Airline School Rd for ~1.8 miles, cross GA 51 onto Airline Goldmine Rd (watch roadsigns and stay on Airline Goldmine) for ~1.7 miles field on the right. From Atlanta: Interstate 85 Exit 173 Lavonia, Turn right onto Jones St (signs for Lavonia/Hartwell/Royston). Continue onto GA-17 S / Augusta Rd for 4.9 miles, turn left onto GA 51 E /Scheafer St for 1.8 miles. Turn right onto Whitewood Rd for ~1.3 miles then slight right onto Airline Goldmine Rd for 0.7 miles and field will be on the right.

FIELD Camping is allowed on the field.

RV’s are to park at the entrance at the top of the hill under the pecan trees. BRING YOUR OWN WATER AND SHADE.

This county is serious about RABIES VACCINATIONS. Please bring your dog(s) Rabies Certificates and Tags with you.

Your Trash/Poop must be taken with you! Please come prepared to be outside. Bring sunscreen, insect repellant,

appropriate clothing for yourself and your dog, hats, sunglasses, rain gear, etc….

MOTEL ACCOMODATIONS

Days Inn Royston 841 Hartwell St., Royston, GA 30662 (1.5 miles from field) $65+ tax. Allows dogs ($10 per dog/per night. Non-refundable up to 30 lbs)

Over 30 lbs $30 per night per dog. 762-847-7100

Super 8 Lavonia 14227 Jones St., Lavonia, GA 30553 (7 miles from field) Double $58.65 per night. King $64 per night. Save 15% if you book early.

Allows dogs ($15 per dog/per night) 706-356-8848

MOTEL 6 128 Frontage Rd., Commerce, GA 30529 (22 miles from Canon) Pets allowed no weigh limit or pet Fee. 855-265-2185

America’s Best Value Inn 165 Eisenhower Dr., Commerce GA 30529 (22 miles from Canon)

$46 + pet fee ($20 per night/per pet) 877-411-3436

Red Roof 30747 Highway 441 South, Commerce, GA (22 miles from Canon) $56.99 per night. 706-355-5183

COURSE PLANS

Saturday 845 Yds

Sunday 900 Yds

Call Name _________________________________

OFFICIAL AMERICAN KENNEL CLUB LURE COURSING ENTRY FORM

Club: AHCOA

Date:

Location: Event type Test Trial

Class: JC QC Open Special Veteran Singles

Breed:

I Enclose Entry fees in the amount of : $

Breeder:

Registration No: Sex: Date of Birth:

AKC No. AKC Litter No. ILP No. Foreign No. & list country Full Name of Dog:

Call Name:

Sire: Dam: Actual Owner(s): Owner’s Address: City: State: Zip: Name of Owner’s Agent/Handler (if any at Trial:)

Please Separate My Hounds Check if hound has been dismissed within the last 6 trials entered. Must be marked in order to qualify for a “clean” trial requirement.

AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org AGREEMENT

I CERTIFY that I am the actual owner of this dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry. I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this trial, and by any additional rules and regulations appearing in the premium list for this trial, and entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. The entry is submitted for acceptance on the foregoing representation and Agreement. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prize money, ribbons, or trophies, I (we) agree to hold the AKC, the event giving club, their members, directors, governors, officers, agents superintendents or event secretary and the owner or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless form any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting there from, sustained by any person or persons, including myself (ourselves) or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.

Signature of Owner or his Agent duly authorized to make the entry:

Telephone:

E-mail Address: