NBA OFFICIAL EVENT ENTRY FORM                

Entry #______________

Registration Fee: $20 Per Show     Champion Class Registration: $20

{Check with registry for pre-entry rates, or multiple dog rates or discounts.} { Pre-entry must be received by 1 week prior to the show dates. }

NBA Registration # __________________   DOB _______________  SEX___________

NBA Registered Name ____________________________________________________

Owner’s Name(s) _________________________________________________________

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Street

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City                                     State                            Zip

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Phone                                                              E-mail 

Check Competition Class Below

By signing, I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event, I (we) agree to hold the NBA, the event-giving club, their members, officers, judges and any provider of services necessary to hold 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 the negligence of the aforementioned parities or any of their employees, agents or any other persons.

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Signature                                                                                                           Date