Torbel's Canine Connection - ORT Registration

ORT Registration

Please fill in the information below to register for the December 1, 2024 ORT in Bourbonnais, IL. No refunds after 5:00pm CST on November 23, 2024.
Handler's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Handler's NACSW Member #*
Dog Information
Dog's Call Name*
Dog's Breed*
Dog's Gender*
Dog's NACSW #*
Please choose the odors you want to test for this dog.
Odors to Test*
prevnext( X )
Birch$30.00

Anise$30.00

Clove$30.00

Total $0.00

Emergency contact Name

First NameLast Name
Emergency contact Phone number

Area CodePhone Number
I/We hereby assume all risks of, and responsiblilty 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 Torbel LTD, Torbel's Canine Connection, 1240 Larry Power Road, Bourbonnais, IL 60914, 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 causes.
Signature

Clear

ORT Registration