Nova Scotia Duck Tolling Retriever Club (USA) (Member of the American Kennel Club)

Transcription

1 Premium List: Event #: Nova Scotia Duck Tolling Retriever Club (USA) (Member of the American Kennel Club) 2015 National Specialty Agility Trial Tuesday, September 15 th, 2015 All Levels Standard, Jumpers with Weaves, FAST & T2B Classes offered Open to Nova Scotia Duck Tolling Retrievers ONLY Entries Limited to 330 Runs. Oshkosh Kennel Club 220 W Packer Avenue Oshkosh WI Method of Entry First Received Entries open Wednesday July 15, 2015 at 8:00am. Any entries received before this date will be returned. No Hand Delivered Entries until 24 hrs after opening date. Any envelope, mailed or hand delivered, containing more than the ten dog maximum constitutes an invalid entry and will be returned. All express mail must be left with no acceptance signature required. Entries close Wednesday August 26, 2015 at 4:00pm after which time entries cannot be accepted, canceled, altered, or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. Show hours: 7:00am-6:00pm AMERICAN KENNEL CLUB CERTIFICATION Permission has been granted by the American Kennel Club for the holding of this event under American Kennel Club Rules & Regulations. James Crowley, Secretary.

2 Mail all entries with fees (check or money order) payable to NSDTRC (USA) to: Lorah Marquardt, Event Secretary, Bluestem Agility Trial Services, LLC 1124 W. River Drive, Stevens Point, WI Questions Call: (715) Or (preferred): Website: Entry fee of $20.00 (US) for the first entry of each dog $20.00 (US) for second entry of same dog, $15.00 (US) each for the third and fourth entry of same dog (includes $3.50 AKC recording fee for first entry and $3.00 AKC recording fee for each additional entry). NOVA SCOTIA DUCK TOLLING RETRIEVER CLUB (USA) OFFICERS President: Kim Simons Vice President: Betsy Fogg Treasurer: Brad Sherlag Secretary: Kim Adams W1951 N Bloomfield Rd Lake Geneva, WI Regional Directors: Region 1: Liz Meacham, Region 2: Dan Rode, Region 3: Terri Krause, Region 4: Lia Riatt, Region 5: Max Hamilton, Region 6: Ann DiSilvestre, Region 7: Jenn Hollis EVENT COMMITTEE Event Chair: Anne Lindsley, 4441 Oak Ridge Court, DePere WI 54115, plindsley@new.rr.com Members: Kathy Guerra, Sue Dorscheid, Carolyn Glenn, Amanda Kaiser Volunteer Coordinator: Carolyn Glenn (847) carolyn@carolynglenn.com TRIAL JUDGE: For All Classes Offered: Sionag Black, 619 Monroe St, Beaver Dam WI golddogs@charter.net PRIZES AND AWARDS: Rosette ribbons will be awarded to First through Fourth place in each class and height division. Qualifying rosette ribbons will be awarded to those dogs receiving qualifying scores. New Title rosettes, Double Q rosettes, MACH and PACH ribbons & bars will also be awarded. Dogs must qualify to receive placement ribbons. Prizes must be claimed the day of the show - none will be mailed. The following will also be awarded for placement in all classes standard and preferred: 1st place in all classes (Std, JWW, FAST and T2B): Custom metal sculpture. 2nd - 4th places in all classes (except T2B which does not give placements beyond 1st): Logo item. TROPHY DONORS: Standard - regular and preferred Jumpers - regular and preferred Novice A: Tammi Stone Novice A: In memory of CH MACH Novice B: In memory of Jenny Aldridge Frog Hollow's Follow Me CD RE WC VCX Open: Brad Sherlag Novice B: Kim Simons Excellent: Anne Lindsley Open: Kelli & Jason Cyr - Master: Carolyn Glenn Sirius Retrievers Excellent: Anne Lindsley FAST - regular and preferred Master: Carolyn Glenn Novice A: General Trophy Fund Novice B: In memory of Jovie, Keepsake's Code Buddy RA AX AXJ NF THD RL1 T2B - regular and preferred : NJ-N NJ-R CGC TDIA VC Pam and Phil Durkee Open: General Trophy Fund Excellent: Anne Lindsley General Trophy Fund: Susan Bograd, Lisa Master: Tim Bauknecht Allmendinger, Tery & Amy Coughlin High Score in Agility Regular Classes: In memory of CH/MACH Westerlea s Midnight Sun UDX RN SH WCX VCX High Score in Agility Preferred Classes: Sponsored by Sue Barnett High in Trial Regular and Preferred: Rosette and Metal Sculpture Art Piece by Artist Esther Benedict Qualifying scores from the regular and preferred Standard and Jumpers with Weaves (JWW) classes count towards HIT. Dogs must be entered in both standard and jumpers to be eligible for HIT awards. Additional classes (FAST and T2B), do not count towards HIT. For purposes of the HIT award, a "Double Q" is defined as qualifying in both Standard and JWW, any level, or a combination of levels, on a single day of the agility trial. Dogs scores and times are compared to the calculated yps for that class, with a value for that difference. The HIT award is calculated by adding these calculated differences of each of a dog s qualifying runs (Standard and JWW). The dog with the highest total score under this formula wins the HIT award. If no dog earns a "Double Q," then the HIT award will be determined by calculating the weighted score from the Standard classes. If there are no standard qualifying scores in any classes, then the award will be based on Jumpers scores. In the event of a tie, the tie will be broken on the basis of the fastest yards per second (yps) achieved in any run by the tied dogs.

3 AKC AGILITY MOVE-UP FORM MOVE-UP REGULATIONS: If a dog earns an AKC agility title before this event, it can be advanced to the next level of competition. However, written notice must be given to the Trial Secretary no later than 6pm on Tuesday, Sept 8, Move-ups will be added to the end of the running order of the class they move up to and every effort will be made to accommodate handlers running multiple dogs in the same class. Move-up form must be submitted Verbal requests will not be accepted. Fill out each change and send to the Trial Secretary s home address. ed requests accepted as long as all information is included AKC Registered Name: AKC Registration #: RUNNING ORDER: 6:30 AM Building opens 7:45 AM Briefing and Walk-throughs 8:00 AM Judging begins T2B Master/Excellent FAST Open FAST Novice FAST Master/Excellent Standard Open Standard Novice Standard Master/Excellent JWW Open JWW Novice JWW Height order: Little to Big Breed: Call name: Owner(s): Day(s) Move-up requested for: Height Division: STD Move to: Open Exc Mas STD Pref Move to: Open P Exc P Mas P JWW Move to: Open Exc Mas JWW Pref Move to: Open P Exc P Mas P FAST Move to: Open Exc Mas FAST Pref Move to: Open P Exc P Mas P ONLINE WORKER SIGN-UP: Please be generous with your time. Volunteers will receive lunch & a drink. Sign up using the link below: Please contact Volunteer Coordinator: Carolyn Glenn, carolyn@carolynglenn.com with any questions. SITE INFORMATION: All classes will be held indoors on stall matting. Ring size is 68ft. x 121ft. Exhibitors and spectators are expected to keep the entire area clean. Anyone witnessed not picking up after their dogs on the trial grounds will be excused from the trial with no entry fees refunded. CRATING: There will be limited indoor crating available. Please be prepared to stack crates and use only the designated crating areas. X-pens and oversized chairs not allowed. Crates may be left overnight, however, NSDTRC (USA), the Oshkosh Kennel Club and Bluestem Agility Trial Services, LLC will not be responsible for any lost or damaged items left at the show site. Dogs may not be left overnight. FOOD: Food will be available on site. MOVE-UP REGULATIONS: If a dog earns an AKC agility title before this event, it can be advanced to the next level of competition. Written notice must be given to the Trial Secretary no later than 6pm on Monday, May 11, Move-ups will be added to the end of the running order of the class they move up to and every effort will be made to accommodate handlers running multiple dogs in the same class. Verbal requests will not be accepted.

4 JUMP HEIGHT DIVISIONS: Owners are responsible for entering the proper height division. Height at Withers Jump Height Regular Classes Jump Height Preferred Classes 11 and under 8 inches 4 inches 14 and under 12 inches 8 inches 18 and under 16 inches 12 inches 22 and under 20 inches 16 inches Over inches 20 inches 26 inch jump height may be entered at the owner s discretion. HEIGHT CARD REQUIREMENT: When filling out the entry form, please designate whether your dog has a valid jump height card or if your dog needs to be measured. Please check the appropriate box so that the Trial Secretary knows whether to include your dog on the list of dogs to be measured. If a measurement is necessary, it is solely the exhibitor s responsibility to have their dog measured prior to running. Exhibitors should have their dog s original, official jump height card or temporary jump height form available at each trial to present upon request.. Regulations for Agility Trials, Chapter 2, Section 4. REFUNDS: No entry fees will be refunded if the trial cannot open or be completed by reason of riots, civil disturbances, fire, act of God, public emergency, act of a public enemy, or any other cause beyond the control of the organizing committee. Entry fees shall not be refunded in the event that a dog is absent, disqualified, excused by a judge, or barred from competition by action of the Trial Committee. Entry fee for bitches that come into season or a dog that is injured after the closing date will be refunded (less $12 administrative fee per day) if a veterinarian s certificate is presented to the Trial Secretary prior to the start of judging on the first day of the trial. OBSTACLES: Obstacles will meet the specifications in the current edition of the Regulations for Agility Trials. A break away tire will be used at these trials. DOGS ELIGIBLE TO ENTER: This trial is open to all dogs fifteen (15) months of age or older that are registered with the American Kennel Club or that have AKC Limited Registration, Purebred Alternative Listing/Indefinite Listing Privileges (PAL/ILP), or approved Foundation Stock Service (FSS) breeds. Bitches in season, aggressive, blind or deaf dogs or dogs suffering from any deformity, injury or illness which may affect the dog s physical or mental performance are ineligible to participate. All American/mixed breed dogs are eligible to enter these trials. RINGSIDE: Dogs are not required to be at the trial until the scheduled time of judging. All dogs not needed for further judging are excused. The owner or handler of each dog is solely responsible for having the dog ready at ringside when the class is to be judged. Please help your fellow competitors, the trial workers, and the judge by checking in with the gate steward well ahead of your turn, and being prompt at the line when your turn comes to run. SAFETY AND BEHAVIOR: The safety of the dogs is our primary concern. By entering this trial, exhibitors acknowledge that they are familiar with the rules and regulation of this sport and that their dogs are familiar with and able to perform all obstacles safely. Exhibitors should follow their veterinarians recommendation to assure their dogs are free of internal and external parasites, any communicable diseases, and have appropriate vaccinations. LIABILITY: It is expressly understood that exhibitors alone are responsible for the behavior of their dogs and/or children. Any exhibitor whose dogs and/or children create unnecessary disturbances or repeatedly engage in unsafe or disruptive behavior may, at the discretion of the Trial Committee, be asked to leave the show site. In such cases, no refund of any fees paid will be made. NFGRC Inc, Oshkosh Kennel Club, Bluestem Agility Trial Services, LLC, and their members, agents, etc. will assume no responsibility for any loss, damage or injury sustained by exhibitors or handlers, or to any of their dogs or property, and further assumes no responsibility for injury to children. NATIONAL SPECIALTY HOST HOTEL: RIVERWALK HOTEL, DOWNTOWN NEENAH 123 E Wisconsin Ave, Neenah, WI Nova Scotia Duck Tolling Retriever Club- $99.00 single/double Please make your reservation by calling the hotel directly at When calling to make reservations, request the Nova Scotia Duck Tolling Retriever Club block or mention group code: NSD. Block Dates: September 13-20, The reservation cutoff date is Sunday, August 16th. ADDITIONAL HOTEL INFORMATION: The following area hotels accept well-behaved people and their pets. Exhibitors must contact hotels directly and identify themselves as having dogs. Some of these hotels do charge an extra fee for dogs. Be sure to verify the dog policy with the hotel of your choice when you make your reservation. Please be a responsible owner and a considerate hotel guest by maintaining a restful atmosphere and cleaning up after your dog. LA QUINTA Rath Lane, Oshkosh, WI HOLIDAY INN 2251 Westowne, Oshkosh, WI (920) HAWTHORNE INN & SUITES 3105 S Washburn St. Oshkosh, WI (920) SUPER W. South Park, Oshkosh, WI (920) FAIRFIELD INN 1800 S. Koeller St. Oshkosh, WI (920) DIRECTIONS TO TRIAL SITE: Oshkosh Kennel Club, 220 W Packer Avenue, Oshkosh WI From North or South: Hwy 41 to Hwy 76/Jackson St (Exit 124). Exit towards Oshkosh, go through 2 sets of stoplights and cross the railroad tracks. Take the next left turn onto Packer Ave. (located between His Church and Fox Valley Thrift Shoppe) continue straight to the OKC clubhouse on the left side of the street. LINK TO MAP: / VETERINARIAN ON CALL: FOX VALLEY REFERRAL CENTER New Horizons Blvd, Appleton WI 54914

5 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Nova Scotia Duck Tolling Retriever Club (USA) September 15, 2015 Opens:7/15/2015 Closes:8/26/2015 Standard FAST Jumpers T2B Entry Fee: 1 st & 2 nd run $20 (US) each; 3 rd & 4 th run $15 (US) each Make checks payable to: NSDTRC(USA) Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (STD, JWW, FAST, T2B) REGULAR Classes STD Nov A Nov B Open Exc Master JWW Nov A Nov B Open Exc Master FAST Nov A Nov B Open Exc Master T2B T2B PREFERRED Classes STD NovP OpenP ExcP MasterP JWW NovP OpenP ExcP MasterP FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes STD JWW ISC Jump Height - Select: or- Jump Height Same as Regular/Preferred This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO Enter Complete Registration # below ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable Exhibitor or owner MUST sign on the signature line beneath the instructions. AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I (we) agree that the club holding this event has the right to refuse 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 prizes, 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 and/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 from 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 therefrom, 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 negligence of the aforementioned parties or any of their employees or 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 THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN ITS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTREPRETATION 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. INSTRUCTIONS Handlers may opt to enter in a higher height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner? I CERTIFY that I am the actual owner of the 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 event, and by any additional rules and regulations appearing in the premium list for this event, and further agree to be bound by the Agreement printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the forgoing representation and agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them. SIGNATURE of owner or his agent duly authorized to make this entry. SIGN HERE X Telephone Number: Address: In Case of Emergency - Name: Phone #: (NOT REQUIRED) New AEAGL2 (12/13)

6 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Nova Scotia Duck Tolling Retriever Club (USA) September 15, 2015 Opens:7/15/2015 Closes:8/26/2015 Standard FAST Jumpers T2B Entry Fee: 1 st & 2 nd run $20 (US) each; 3 rd & 4 th run $15 (US) each Make checks payable to: NSDTRC(USA) Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (STD, JWW, FAST, T2B) REGULAR Classes STD Nov A Nov B Open Exc Master JWW Nov A Nov B Open Exc Master FAST Nov A Nov B Open Exc Master T2B T2B PREFERRED Classes STD NovP OpenP ExcP MasterP JWW NovP OpenP ExcP MasterP FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes STD JWW ISC Jump Height - Select: or- Jump Height Same as Regular/Preferred This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO Enter Complete Registration # below ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable Exhibitor or owner MUST sign on the signature line beneath the instructions. AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I (we) agree that the club holding this event has the right to refuse 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 prizes, 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 and/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 from 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 therefrom, 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 negligence of the aforementioned parties or any of their employees or 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 THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN ITS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTREPRETATION 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. INSTRUCTIONS Handlers may opt to enter in a higher height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner? I CERTIFY that I am the actual owner of the 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 event, and by any additional rules and regulations appearing in the premium list for this event, and further agree to be bound by the Agreement printed on the reverse side of this entry form. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the forgoing representation and agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them. SIGNATURE of owner or his agent duly authorized to make this entry. SIGN HERE X Telephone Number: Address: In Case of Emergency - Name: Phone #: (NOT REQUIRED) New AEAGL2 (12/13)