8^ MEDITERRANEAN CUP - 8^ COPPA DEL MEDITERRANEO
ENTRY FORM FOR BRITISH POINTERS – ISCRIZIONE RAZZE BRITANNICI
ITALIA – PIEVE S.STEFANO – AR – 22/23 OTTOBRE 2014
NATIONALITY
NAZIONE
___________________________________________________________________
NAME OF THE DOG
NOME DEL CANE
___________________________________________________________________
YES/SI
RESERVE DOG
CANE DI RISERVA
SEX/SESSO
M
DATE OF BIRTH/DATA DI NASCITA
TATOO/TATUAGGIO
F
BREED/RAZZA
BREED/RAZZA ___________________________________
_________________________
____________________________CHIP
___________________________
_
____________________________CHIP NO./MICROCHIP __________________________
N. WORKING BOOK/N.LIBRETTO
BOOK/N.LIBRETTO ___________________________________________________________________
DRIVER NAME/NOME CONDUTTORE ________________________________________________________________
ANDRESS/INDIRIZZO ____________________________________________________________________________
COUNTRY/CITTÀ
____________________________________________________________________________
CELL.PHONE/CELLULARE
CELL.PHONE/CELLULARE ___________________________PHONE/TELEFONO ___________________________
____________________________
_____________
FAX __________________________________________E__________________________________________E-MAIL __________________________________________
OWNER NAME/NOME PROPRIETARIO ______________________________________________________________
Cost of entry fees for dog and for day : €. 40,00 /quota di iscrizione per ogni cane al giorno €. 40,00
Send the entry form to :/inviare il modulo di iscrizione a :
ADDRESS where the entry forms must be sent within OCTOBER 8, 2014
Paolo Andreini : Tel. and Fax 0039 0575 489874 – mobile 00393336922085
e-mail : [email protected]