§910.EXHIBIT A. Application Form

Field Trial Organization Name:

Contact Person's Name:

Contact Person's Address:

City:

State:

Zip:

Email Address:

Work Phone:

(       )

Home Phone:

(       )

Fax Number:

(       )

Cell Phone:

(       )

Dates of Field Trials:

Location of Field Trial:

Des Plaines CA

Pyramid SP − Captain Unit

Jim Edgar Panther Creek SFWA

Pyramid SP − Denmark Unit

Hamilton Co. SFWA

Pyramid SP − Galum Unit

Moraine View SP

Wayne Fitzgerrell SP

Middle Fork SFWA

Other

Type of Field Trial:

Pointing Dog − Horseback

Retriever

Pointing Dog − Walking

Flushing Dog − Shoot-To-Retrieve

Pointing Dog − Shoot-To-Retrieve

English Springer Spaniel

Beagle Hound

Fox Hound

Coon Hound

Other

Licensing or Sanctioning Sporting Dog Registry or Association if Applicable:

American Kennel Club (AKC)

American Rabbit Hound Association (ARHA)

National Shoot-To-Retrieve Field Trial Association (NSTRA)

United Kennel Club (UKC)

The American Field – Field Dog Stud Book (AFDSB)

Amateur Field Trial Clubs of America (AFTCA)

National Kennel Club (NKC)

Professional Kennel Club (PKC)

Club Sponsored Event

Request must be received at least four weeks prior to the date of the field trail.

Fees:    Pointing Breed, Horseback Fox Hound, Retrieving Breed and Flushing Breed Field Trials − $70 per day

Beagle and Coon Hound Field Trials − $25 per day

A current certificate of liability insurance valid for the dates of the field trial must either be on file with DNR or attached to this application.

Submit application to: IDNR, Attention: Field Trial Program, One Natural Resources Way, Springfield IL 62702-1271; Phone:  [phone]; Fax:  [phone]

 

(Source:  Added at 29 Ill. Reg. 8295, effective May 26, 2005)