JEFSS1 0819 v1.1 Edit© 2019 American Kennel Club, Inc.

Report of FSS Open Show or 4–6 Month Beginner Puppy Event

(Licensed or Member Clubs Only)Upon completion of an FSS Open Show or 4-6 Month Beginner Puppy event, the Superintendent or Event Secretary must fill out this report. This report along with the event records described in the Rules Applying to Dog Shows, Chapter 17, Section 2, and the appropriate fees must be sent to Event Operations at the American Kennel Club, PO Box 900051, Raleigh, NC, 27675-9051. Please answer all questions and print clearly; if additional space is needed please attach 8 ½“X 11” paper only.

These results must be received by Event Operations within seven days after the event.PLEASE COMPLETE THIS FORM EVEN IF THERE ARE NO ENTRIES

Office Use Only

Name of Club Date of Event Event #Submission Items

Please submit the following within seven days of the event.

Marked catalogJudges booksThis form with both pages completed

Payment attached to this form(check or credit card info—Do not email Credit Card number)

Mail to this addressAmerican Kennel Club

Event Operations Conformation/Obedience

PO Box 900051 Raleigh, NC 27675-9051

Payment MethodCheckCheck Number Amount of Check

Credit CardCredit Card Number

Expiration Date Card Type

Name on Credit Card

Billing Address

Questions? Contact us. . .American Kennel Club

Event Operations PO Box 900051

Raleigh, NC 27675-9051Tel 919 816-3579Fax 919 816-4220

www.akc.org

FeesOpen Show or 4–6 Month Beginner PuppyEvent Service Fees are $2.00 per entry (not per dog) per Open Show Regulations Chapter 2, Section 5 or Beginner Puppy Regulations, Section 5.

Number of entriesService Fee $2.00 per entry (not per dog)Total Entry Service Fee for this event$

2.00

JEFSS1 0819 v1.1 Edit© 2019 American Kennel Club, Inc.

CommentsWere there any complaints against any judge? If so, list name of complainant, basis of complaint, and name and number of the judge. If you have any supporting documentation, attach it to this report.

If any judge arrived late for assignment, give details:

Name ReasonName Reason

Did all judges approved on the panel for this event by the AKC® officiate? Yes No If not, list the judges that did not officiate below, the date the club was notified, and the reason given to the club:

Name Date ReasonName Date Reason

If any judges were used at this event that have NOT been approved previously by the Judging Operations Department of

the AKC®, list their names and addresses and the additional breed(s) judged:

Name AddressBreed(s)Name AddressBreed(s)

Event Committee Record Submission RequirementsPer the requirements in Dealing with Misconduct at American Kennel Club Events, records pertaining to any complaints received by the Event Committee and/or civil authorities in relation to this event must be submitted to the AKC within 5 days of the event. Records should be submitted whether the Event Committee acted or not.

Incidents involving dog aggression (except in the case of a dog that is disqualified by the judge) are required to be documented by the Event Committee and all forms and records must be emailed to eventrecords@akc.org or faxed to the attention of Event Operations at (919) 816-4220 within 72 hours of the event.

Additional Comments

Signature of Show Secretary Date

Printed Name of Show Secretary

Email Address Phone Number