DATE _______________________________

JUNIOR HANDLER'S NAME ______________________________________________________________

DATE OF BIRTH _____________________ JUNIOR'S AKC #____________________________

ADDRESS______________________________________________________________________

CITY, STATE, ZIP _______________________________________PHONE_________________________

Proof of Eligibility

GPCA MEMBER (Family name) _______________________ RELATIONSHIP__________________

Signature of Parent/Legal Guardian_________________________________________

Signature of Principal or Teacher confirming that the Junior Handler has commendable academic achievements._______________________________________

Must be completed and submitted by March 1st of the Award Year to:

Ruth A. Marcy, 11146 Totem Road, Anchorage, Alaska 99516