DATA ESSENTIAL FORM

NAME OF CLUB: ____________________________ Date of Trial:_______________

PLACE OF TRIAL: ________________________One Course ____ Multiple Course___

TITLE OF STAKES: _____________________________    Length of Heats: _______

Trial run in accordance with minimum requirements: ___ Yes ___ No
For Dogs Whlped on or After (Give Date) :  ________________________

TOTAL # OF DOGS DRAWN: _____ (# Pointers _____, #  Setters ____, # Others ____)

JUDGES: ______________________________________________________________
(Name)                                                    (Address)
______________________________________________________________________
Name)                                                      (Address)

1st Place To __________________________________   Breed _______  Sex _____

Reg. No. _____________   Whelping Date: ____________   Color: _______________

Sire: _______________________________    Dam: ___________________________

Owner _____________________   Mailing Address ___________________________

Handler ____________________   Mailing Address ___________________________

2nd Place To ___________________________________   Breed _______  Sex _____

Reg. No. _____________   Whelping Date: ____________   Color: _______________

Sire: _______________________________    Dam: ___________________________

Owner ____________________   Mailing Address ____________________________

Handler ___________________   Mailing Address ____________________________

3rd Place To __________________________________   Breed _______  Sex _____

Reg. No. _______________   Whelping Date: ____________   Color: _____________

Sire: ______________________________    Dam: ____________________________

Owner ____________________   Mailing Address _____________________________

Handler ___________________   Mailing Address _____________________________

________________________________       __________________________________
Judges Signature                               Judges Signature