Name:__________________________________________________________________

Address:________________________________________________________________

________________________________________________________________________

Phone Numbers:_________________________________________________________

Email Address:__________________________________________________________

1.  I am a member/supporting member of the National Beagle Club in good standing. __________

2.  I am currently in good standing with the AKC. ___________

3.  Have you ever had your privileges suspended by the AKC? __________

If YES, please explain on a separate sheet of paper.

4.  I am a licensed AKC breeder judge with approved status. ___________
If YES, please provide AKC license number and proceed to QUESTION #10. ___________

5.  I have 12 or more years experience exhibiting beagles in conformation. __________

6.  I have bred & raised 5 or more litters of beagles on my premises. __________

7.  Please list the dam’s registered name and whelping date(s).

 ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

8.  I have bred & raised 4 or more beagle champions on my premises. ____________

9.  Please list the champions’ names and AKC numbers.

_______________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

10.  I am willing to provide kennel visits for aspiring judges. ____________

11.  I am willing to present beagle seminars even if some travel is involved at my own expense. ____________

12.  I am willing to provide ringside mentoring. ____________

13.  I agree to use NBC materials for seminars. ____________

14.  I have attended a NBC National Specialty within the past 5 years. ____________

15.  I agree to attend a NBC National Specialty at least once every 5 years to maintain my mentoring status. ____________

Signed:_______________________________________________ Date: ____________

MAIL TO:

Peggy Shaw, Judges Education Committee

2121 Shaw Road, Walnut Hill, IL 62893