NACSW

Anne Rosenberg / ev-ry earthdog 

NACSW™ – Odor Recognition Test  

$35.00 Registration Fee - Payment by PayPal as friends and family to annelrosenberg@hotmail.com  Please mail this completed form via email with your registration fee to: annelrosenberg@hotmail.com   Questions: Contact: Anne Rosenberg (609) 519-8289 or annelrosenberg@hotmail.com   

Odor: □ Birch            □ Anise                □ Clove  

Test date(s): 

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 _____________________________________________________  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 Anne Rosenberg and ev-ry earthdog of Mt Laurel, NJ 08054,, 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: ______________________