NDGAA ONLINE WORKSHOP & CERTIFICATION PRE-REGISTRATION FORM
*Please fill in the location that you are pre-registering for (check for event location & date on our Event Schedule
*Fill out the Form in full.
*Complete the payment section and hit the SUBMIT

 

Pre-Registration by Credit Card Payment

PERSONAL INFORMATION

  * Required Information
     
*First & Last Name:    
*Address:    
*City, State-Prov:    
*Zip-Postal Code:    
*Country:    
*Date of Birth:    
*Cell Phone:    
*Email Address:    

Mail Any NDGAA Materials to:

  My Home Address  My Salon Address
     

*Salon Name:

 
*Salon Address  
*Salon City, State, & Zip:  
*Salon Phone:  
*Salon Website:  
*Your Position:  
*How Long in Business?  

*Type of Facility - Land Base or Mobile?

 
     
     
*Testing/Workshop Location    
*Event Date    
     
    Full Workshop – $125 Non-Member fee
Full Workshop – $110 Member fee

Mini Workshop - $75 Non-Member fee
Mini Workshop - $65 NDGAA Member fee
 
Non-Sporting $125   Sporting $125
Terrier $125 (2 Terriers + Written/Practical Test)    
     
MEMBERS ONLY:   Long Legged Terrier $75
    Short Legged Terriers $75
    Non-Sporting Written $60
    Sporting Written $60
    Terrier Written $60
    Master Exam $125
     
  Breed Study Kit

NDGAA Breed Profile Study Kit – $45

     
     

How Do You Propose to Pay?

 
Proposed Payment Method Credit Card Online  Credit Card By Fax
Mailing Check/Money Order

Type of Credit Card to process?

 
Credit Card Visa  
MasterCard
American Express
Discover

Credit Card Number:

   
Name on Credit Card:    
Billing Address for Card:    
City, State-Prov, Zip-Postal:    
Expiration Date - (Example 05/12)        Security Code (CVS)  
     
     
Charge Authorization, Your Consent and Electronic Signature
PAYMENT & LIABILITY AGREEMENT:

I am in agreement and hereby authorize NDGAA to charge my credit card in the amount of $ in payment for my Pre-Registration fees. Your Name -   by typing my name I hereby agree that neither NDGAA, nor the event host hotel or business, their sponsors, agents, employees, or representatives shall be liable for any loss, damage, harm or injury to the property or person of the applicant or its representative resulting from fire, accident, theft or other causes. Attend at your own risk - I/We hereby agree that I/We have read and understand this policy, and I/We Hereby Acknowledge that having read and understand the limits of liability for this event I/We agree to the risk liability. Please click the SUBMIT tab once you have completed all information. By typing my name and entering the total fees to be charged to my credit card, I agree this will serve as my Electronic Signature.
 

 

 

Once you click the Submit tab
it takes about 20-25 seconds for
the data to submit - please be patient

 

We accept Visa, MasterCard & American Express

P.O. Box 101,   Clark, PA 16113 - Ph.  (724) 962-2711 - Fax  (724) 962-1919

Top