TWELFTH ANNUAL NORTH DAKOTA PHEASANT CHAMPIONSHIP 

ROUGHRIDER GUN DOG CLUB
ENTRY FORM AND LIABILITY RELEASE  

HANDLER: 

        NAME    ______________________________________________________________  
        ADDRESS ____________________________________________________________
        PHONE   _____________________________________________________________

DOG #1: 

        REGISTERED NAME ____________________________________________________
        BREED           __________________________________________________________
        SEX             ____________________________________________________________
        SPONSOR (if any)________________________________________________________

DOG #2: 

        REGISTERED NAME _____________________________________________________
        BREED         ____________________________________________________________
        SEX             _____________________________________________________________
        SPONSOR (if any)_________________________________________________________

ND PHEASANT CHAMPIONSHIP -  ENTRY FEE:     $150/dog

Make check payable to Roughrider Gun Dog Club
 

Drawing 4:00 pm day before trial

WAIVER OF LIABILITY  - The Roughrider Gun Dog Club, Roughrider Gun Dog Club officers and Board of Directors, land owners and land renters on whose land the trial will be held, are not responsible for any accident, injury, death or loss to any person, horse, dog or equipment.  I certify that I am 18 years old or older.  I also certify that I have read and agree to abide by the official field trial rules for the North Dakota Pheasant Championship.  I realize that hunting and field trialing are inherently dangerous sports which involve substantial risk of injury or death.  I voluntarily assume that risk and agree to hold harmless for any accident, injury, death or loss to any person, horse, dog or equipment, The Roughrider Gun Dog Club, Roughrider Gun Dog Club officers and Board of Directors, land owners and land renters on whose land the trial will be held.  This waiver of liability is given freely by me and on my own behalf and shall be binding on myself, my heirs, assigns, or representatives of myself and/or my estate.

SIGNATURE______________________________________ DATE _______________ 

Trial to be held 10 miles northwest of Regent, North Dakota along the Cannonball River.