| B.N.F.C. - C.B.T.N. |
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| BREVETTEN -
BREVETS� - GRADEN - CERTIFICATES |
| WATERWERKEN -
TRAVAIL A L'EAU - WASSERARBEIT - WATER TESTS |
| ZATERDAG -
SAMEDI - SAMSTAG - SATURDAY - 21/06/2003 |
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| Inschrijvingsformulier
- ��n formulier per hond / Bulletin d'inscription - un seul par chien |
| Anmeldungsformular
- ein Formular pro Hund / Registration form - one for each dog |
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| Naam/Nom/Name |
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| Straat/Rue/Strasse/Street |
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Nr./N� |
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| Postcode/Code
Postal/Postleitzahl |
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Land/Pays/Stat/Country |
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| Woonplaats/Domicile/Wohnort/Place |
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| Naam-Nom-Name/Hond-Chien-Hund-Dog |
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| Stamboom
nr./P�digree n�/Zuchtbuch nr./Pedigree nr. |
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| Reu/M�le/Rude/Male |
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Teef/Femelle/Hundin/Bitch |
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| Geboortedatum/Date
de naissance/Wurfdatum/Date of birth |
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| BREVET / GRADE
/ CERTIFICATE |
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| Deelname aan/Participation �-at/Teilnahme an :������������������� A of/ou/oder/or B of/ou/oder/or C |
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| INSCHRIJVINGSGELD/FRAIS
D'INSCRIPTION/ANMELDUNGSGEBUHR/REGISTRATION FEE |
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| Per hond/Par
chien/Pro Hund/For one dog :
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Lid:Membre/Member
: � 15
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Niet-leden/Non membres/Non members : � 20 |
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| BETALING -
PAYEMENT - ZAHLUNG - PAYMENT |
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| Bankrekening -
Compte bancaire - Bankkonto - Bank account 140-0517070-30 BNFC-CBTN |
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| Inschrijving/Inscription/Anmeldung/Registration
: Voor/Avant/Vor/Before 08/06/2003 |
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| Naar/A/Zu/To :
Maria Teunckens, Eersbekeweg 16, B-9500 Geraardsbergen |
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| Datum/Date |
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Handtekening/Signature/Unterschrift : |
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����������������.. |
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