Iowa Cow Dog Club Nursery Challenge Entry Form

October 9 & 10, 2010 @ Gary Goehring 18594 Hwy. 1      Keosauqua IA 52565

See website for all the rules: 2010 Nursery Challenge Info

Payment Schedule
Due:                                           If paid late

Dec. 1st, 2009                 $50                          $100

April 1st, 2010                 $50                          $200

Aug. 1st, 2010                $150                          $400

Make checks payable to: Goehring Auction Service

Send entries to: Ed Ball    2169 637^th Trail    Albia IA 52531

Info: www.iowacowdogclub.com justask@iowacowdogclub.com 641-919-0865 (Gary's cell phone)

2^nd Payment (see schedule for amount and due date) 3^rd Payment (see schedule for amount and due date)

Dog:________    Dog: Dog:     Dog: Dog:    Dog:

1^st Payment SE IA Cow Dog Nursery Challenge
(This form MUST be filled out to be entered) Only for dogs born on or after Jan. 1^st, 2008

Dog: Birthdate:_ Sex:_ Handler/Owner:_________

Dog: Birthdate:_ Sex: Handler/Owner:_______

Dog: Birthdate:_ Sex: Handler/Owner:___

In consideration that my dog(s) and I will be participating in the SE IA Cow Dog Nursery Challenge, I understand that I am responsible for any cost incurred as a result of the damages caused by me, my family, my guest or my dogs to the facilities, animals or people. I hereby agree that in the event of personal injury or damage to my property or animals I will not hold Goehring Auction Service, Gary Goehring and family, Trial Sponsors, stock handlers, helpers or other property owners responsible.

Signature:_Print Name:

Address: City:___   State:_

Phone #:_ Email Address:________________

Make checks out to : Goehring Auction Service
Send entries to: Ed Ball       2169 637^th Trail       Albia IA 52531