Alaskan Malamute HELP League Versatility Award (AVA) Certification  Application Form

Owner's Name: _________________________________________________ Phone: ________________

Address: ____________________________________________________________________________

City: ________________ Prov./State: ____________ Zip/PostalCode: _____________

I/We apply for certification for the following dog: (Registered name if applicable)

_________________________________________________________________________

In order for a dog to qualify for the AMHL Versatility Award, we must receive documentation (or copies thereof) to show that this dog has received recognition in each of the three following areas:

1	Working Title
	One working title from the programs offered by AMHL, AMCC, AMCA, AKC or CKC;
	____________________________________
	title
	________________________________________________________________________
	sanctioning body

2	Temperament Title
	CGC certificate, Temperament Test Certificate as offered by Temperament Test Associates, Therapy Dogs International, or St. John Ambulance;
	____________________________________
	title
	________________________________________________________________________
	sanctioning body

3	Additional Title
	Another CKC, AKC or UKC title (excluding sledding titles, as they are included in # 1). This includes conformation, obedience, agility, flyball, etc.
	____________________________________
	title
	________________________________________________________________________
	sanctioning body

*	Special to Service Dogs
	A special Versatility Award will be made to any dog that has been certified as a service dog (search and rescue, guide dog, etc.)
	____________________________________
	title
	________________________________________________________________________
	sanctioning body

Note: Form must be fully completed with all documentation or it will not be processed.

All necessary forms must be sent with application fee of $10.00 submitted at the same time to:

Klaus Nielsen, Box 44, Richmond ON Canada K0A 2Z0

Please make cheques payable to the Alaskan Malamute HELP League

For official use: Received: Date & Initial ______________________