Please print this page and mail with check payable to TBCC to:
Myrle Hale
12860 Thonotosassa Rd.,
Dover, FL 33527



THE CLOSING DATE FOR THE HEALTH TESTS IS THE SAME AS THE CLOSING DATE FOR SHOW ENTRIES.

Additional information concerning CHIC.
In order to register your results with CHIC, dogs must be over 1 year of age and be permanently identified with a microchip or tatoo.
The testing will be performed on the day of the show from 3:00pm to 5:00pm.
You must arrive 15 minutes BEFORE your Appointment Time in order to add Dilation drops to your dogs eyes (drops last from 2-6 hours om average).
PRE-REGISTRATION IS REQUIRED.  WALK-INS WILL NOT BE TAKEN. 
                     PLEASE PRINT FORM--- ONE DOG--ONE FORM EACH

         Dogs NOT entered in the show, but are there for the Health Testing Clinic should be kept in the designated area of the room away from the show ring.

The individual costs for the tests:    CARDIAC.......$10.00
                                                     PATELLAS.......$10.00
                                                             EYES...... $20.00
                                                     MICROCHIP.... $13.00
                             
(please make check payable to Tampa Bay Chihuahua Club)


   Registered owners name:_______________________________________________

    Test(s) requested and amount enclosed: ____________________________________

    ____________________________________________________________________

    Address:  ____________________________________________

    City: ________________________________________________

   State: _____________________  ZIP: _______________________

 phone: ________________________  E-MAIL:___________________________________

 Dogs Registered Name: ___________________________________________________

 AKC Registration Number: ________________________________________