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:

County:

Property Owner's Name:

Distance & Direction From Nearest Community:

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 Field 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 trial.

Submit application to: IDNR, Attention: Field Trial Program, One Natural Resources Way, Springfield IL 62702-1271; Phone:  (217)782-6752; Fax:  (217)524-5612