ORT Entry Form – WE’RE FULL! Contact me if you’d like to be placed on the waitlist. Foxfiredogs@gmail.com

Cynthia Fox

NACSWTM – Odor Recognition Test

Saturday, February 19, 2022
Heard Scout Pueblo, 1901 E. Dobbins Road, Phoenix, AZ 85042
$35.00 Registration Fee per odor- Payment by check or money order with registration.

Questions: Contact: Cynthia Fox, Foxfiredogs@gmail.com
Odor: □ Birch □ Anise □ Clove
Test date: Saturday, February 19, 2022
Dog’s Call Name _________________________________________
Breed(s) ______________________

Dog’s NACSW #________________
Handler’s Name _____________________________________________________ Handler’s NACSW Membership # ____________________________________ Address _______________________________________________________
City __________________ State _________ Zip________

Phone where you can easily be reached __________________________ 

E-mail Address _____________________________________________________

Please mail this completed form via USPS with your registration fee to:
Cynthia Fox, 18412 N. Summerbreeze Way, Surprise, AZ 85374

An ORT must be taken and passed at least 14 days before a trial opening date to be eligible for the first draw period.

Please contact your host at least 1 day before the ORT if your female dog will be in season.

All confirmations will be sent via e-mail with attachment within 7 days of receipt of complete registration form and payment. If you require a confirmation via USPS, you must provide a self-addressed stamped envelope.

I/We hereby assume all risks of, and responsibility for, accidents and/or damage to myself or to my property or to others, resulting from the actions of my dog. I/We expressly agree that Cynthia Fox, Heard Scout Pueblo, and/or NACSW or any other person, or persons, of said groups, shall not be held liable personally, or collectively, under any circumstances, for injury, and/or damage to my person, for loss or injury to my property, whether due to uncontrolled dogs or negligence of any member of said groups, or any other cause, or causes.

Signed: ___________________________________Date: ______________________

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