3RD AKC RALLY® NATIONAL CHAMPIONSHIP
Friday, March 18, 2016 Opening Date – Monday, December 28, 2015 at 10:00 a.m. Eastern Time Closing Date – Friday, February 12, 2016 at 4:00 p.m. Eastern Time Entries are limited and will be accepted on a first-come, first-serve basis, as follows: ENTRY LIMITS Novice Class – 80 Excellent Class – 80 Advanced Class – 80 RAE Class – 160 Central Park Hall at Expo Square 4145 East 21st Street, Tulsa, OK 74114 Event Hours: 7:00am to 7:00pm Mrs. Nancy Craig, Riverside, CA
Judges: Mrs. Brenda Crim-Critelli, Parrish, FL
Mrs. Selina Edney, Hendersonville, NC
Ms. Beth Fitzgerald, Madison, AL
Dr. Sandy Gould, Joliet, IL
Ms. Diane Stout, Langhorne, PA
Mrs. Julie Yamane, Fort Collins, CO CERTIFICATION
Permission is granted by the American Kennel Club for the holding of this event under American Kennel Club rules and regulations. James P. Crowley, Secretary
EXECUTIVE OFFICERS OF THE AMERICAN KENNEL CLUB Dennis B. Sprung, President & CEO 260 Madison Avenue, New York, NY 10016-2408 James P. Crowley, Exec. Secretary 260 Madison Avenue, New York, NY 10016-2408 Joseph V. Baffuto, Jr., Chief Financial Officer 260 Madison Avenue, New York, NY 10016-2408
BOARD OF DIRECTORS Ronald Menaker, Chairman Carl C. Ashby, III, Vice Chairman Class of 2016 Patricia M. Cruz William J. Feeney Thomas Powers
Class of 2017 Lee Arnold Carl C. Ashby, III Alan Kalter Harvey Wooding
Class of 2018 James Dok Dr. Charles Garvin Ronald Menaker
Class of 2019 Dr. Carmen L. Battaglia Dr. Thomas M. Davies Steven D. Gladstone, Esq. Dennis B. Sprung, Ex Officio
VICE PRESIDENTS Michael Basone Technology
Gina DiNardo Assistant Executive Secretary
Mark Dunn Registration & Customer Development
Keith Frazier Optimization & Support Services
Doug Ljungren Sports & Events
Mari-Beth O’Neill Sport Services
Daphna Straus Business Development
Pamela Manaton Director – Obedience, Rally & Tracking 8051 Arco Corporate Drive, Ste. 100 Raleigh, NC 27617
Diane Schultz Sr. Exec. Field Representative 8051 Arco Corporate Drive, Ste. 100 Raleigh, NC 27617
EVENT SECRETARY Lisa Liggins Strickland 8051 Arco Corporate Drive, Ste. 100 Raleigh, NC 27617 [email protected]
AKC RALLY NATIONAL CHAMPIONSHIP EVENT COMMITTEE Pamela Manaton Director, Obedience, Rally & Tracking
Diane Schultz Sr. Exec. Field Representative
Doug Ljungren Vice President – Sports & Events
Mary Higdem Exec. Field Representative
Sharon Hodgens-Wood Exec. Field Representative ®
AKC RALLY NATIONAL CHAMPIONSHIP JUDGES Mrs. Nancy Craig, #3601 15730 Silver Spur Road Riverside, CA 92504-5736
Mrs. Brenda Crim-Critelli, #40791 17716 Roanwood Court Parrish, FL 34219-6000
Mrs. Selina Edney, #40717 1074 Green Mountain Road Hendersonville, NC 28792-2035
Ms. Beth Fitzgerald, #90898 100 Huntington Ridge Road Madison, AL 35757-8500
Dr. Sandy Gould, #92112 501 Terry Drive Joliet, IL 60435-5325
Ms. Diane Stout, #22965 132 Summit Avenue Langhorne, PA 19047-2120
Mrs. Julie Yamane, ##22661 716 Parkview Drive Fort Collins, CO 80525-2733 ®
AKC RALLY NATIONAL CHAMPIONSHIP SUPPORT Rick Garvin Chief Volunteer Coordinator
Paula Spector Hospitality
OFFICIAL EVENT PHOTOGRAPHER Pix ‘n Pages PO Box 690733, Orlando, FL 32869 Phone: (407) 539-PAWS (7297) Email: [email protected]
PUBLICATION RIGHTS – PHOTOGRAPHS AND VIDEOS By entering this show, all owners, handlers, breeders and kennels agree that all rights to televise, videotape, photograph, advertise, promote and publicize or otherwise exploit this show, or the persons or animals participating in it or the results of the competition before, during or after the event, shall belong solely to Mars, Inc. and The American Kennel Club and their respective assigns, including the use of the names, likenesses or biographical matter of all dogs, owners, handlers, breeders and kennels participating in the show and no such owner, handler, breeder or kennel shall allow any other party to make commercial use of any videotape or photograph of any person or animal participating in this competition. NOTE: By entering this show all owners, handlers, breeders and kennels agree to make themselves available for interview if requested. Exhibitors may video tape individual runs only for personal use. Award photos will follow the completion of the event on Friday. Award recipients are requested to wait for photographs. A group photo will be taken for the top four placements in each class and a group photo of the First Place winners in the four classes immediately following the Award Ceremony.
EMERGENCY SERVICES Fire/Ambulance/Police Dial ~ 911 VETERINARY SERVICES The Veterinary will be listed at a later date. Exhibitors should follow their veterinarian’s recommendations to assure their dogs are free of internal and external parasites, any communicable diseases, and have appropriate vaccinations. A copy of a dog’s vaccination record, including a current rabies certificate, must be present for all dogs at the event. ®
AKC RALLY NATIONAL CHAMPIONSHIP DESCRIPTION & SCORING The AKC Rally® National Championship (RNC) will consist of four classes. Each Novice, Advanced and Excellent entry will compete twice in the class entered and each Rally Advanced/Excellent (RAE) entry will compete a total of four times, twice in Advanced and twice in Excellent. Cumulative scores and times will be used to determine placements in each of the four classes. If there are any ties for placements, each team will run once for score and time. In the case of ties for RAE placements, the team will run an Excellent course. For this National Event, scoring will be in accordance with the AKC Rally® Regulations with the following exceptions: The first attempt/performance of each station will be evaluated and scored accordingly. Failure to perform the principal parts of any station on the first attempt/performance will result in an Incorrectly Performed (IP) -10 points penalty. There will be no retries allowed for any station. There will not be any 3 point retry penalties. The maximum penalty for each station will remain at 10 points. ®
AKC RALLY NATIONAL CHAMPIONSHIP DOG ELIGIBILITY The RNC is open to all dogs that are 6 months of age or older and meet the criteria below. In order to be eligible to enter dogs must be registered with the American Kennel Club or have an AKC Limited Registration, ILP/PAL, or an AKC Canine Partners listing number, or approved FSS breeds eligible to participate. Dogs may only be entered in one class and must be entered the highest level they are eligible. Qualifying Period for the event is December 1, 2014 – November 30, 2015. All references to titles indicate AKC titles. ®
AKC RALLY NATIONAL CHAMPIONSHIP DOG ELIGIBILITY •
Rally Novice Class Qualifications o Dogs must have earned a confirmed Rally Novice (RN) title during the qualifying period. o At least three (3) Novice scores of 90 or more, earned during the qualifying period, are required.
Rally Advanced Class Qualifications o Dogs must have earned a confirmed Rally Advanced (RA) title during the qualifying period. o At least three (3) Advanced scores of 90 or more, earned during the qualifying period, are required.
AKC RALLY NATIONAL CHAMPIONSHIP DOG ELIGIBILITY CONT’D •
Rally Excellent Class Qualifications o Dogs must have earned a confirmed Rally Excellent (RE) title during the qualifying period. o At least three (3) Excellent scores of 90 or more, earned during the qualifying period, are required.
Rally Advanced and Excellent Class Qualifications o Dogs must have earned a confirmed Rally Advanced Excellent (RAE) title at any time prior to, or during; but no later then by the end of the qualifying period. o Dogs must have earned three (3) scores of 95 or more during the qualifying period in either Advanced B or Excellent B. o Dogs must have earned at least five (5) double qualifying scores from the Advanced B and Excellent B classes during the qualifying period.
Entries will be arranged according to the jump height of the dogs, per Chapter 4, Section 5 of the AKC Rally® Regulations.
ENTRY FEES PER DOG Rally Novice Class Rally Advanced Class Rally Excellent Class Rally Advanced/Excellent Class
$75.00 $75.00 $75.00 $125.00 ®
OFFICIAL AKC RALLY ENTRY FORM & INFORMATION The entry form can be located on the AKC Rally® National Championship webpage, http://www.akc.org/events/rally/national/. Opening Date/Time for entries is Monday, December 28, 2016 at 10:00 a.m. Eastern Time Closing Date/Time for entries is Friday, February 5, 2016 at 4:00 p.m. Eastern Time Entries will be accepted on a first-come, first-serve basis and will not be accepted until the date and time listed above. Entries not on the Official AKC Rally® National Championship Entry Form or photocopies of the entry forms without the Agreement and Rules on the reverse side are NOT ACCEPTABLE. No entry shall be made or accepted, which specifies any conditions as to its acceptance. In order to submit your entry: It must be delivered by USPS, or a multi-state or multi-national postal or carrier service including but not limited to USPS, FedEx, UPS, DHL, etc. No entries will be accepted by hand delivery or phone. Mail entry forms and fees to: American Kennel Club, Attn: Companion Events, Rally National Championship Entry, 8051 Arco Corporate Drive, Ste. 100, Raleigh, NC 27617. Please make checks or money orders payable to AKC Rally® National Championship. Inquiries may be directed to Lisa Strickland at [email protected]
Dog’s Call Name: Please be sure to include your dog’s call name on the entry forms. This will be used for award announcements. Errors on Entry Forms: Owners are responsible for errors on entry forms and no entry fee will be refunded in the event of such errors or cancellation of entries after the trial has closed. Illegible entries: Will not be processed and will be returned to the exhibitor. Returned checks do not constitute a valid entry. A twenty-five ($25.00) dollar collection fee will be added to the amount of each returned check.
OFFICIAL AKC RALLY ENTRY FORM & INFORMATION CONT’D Limited Entries: Entries will be limited to 80 in Rally Novice, 80 in Rally Advanced, 80 in Rally Excellent and 160 Rally Advanced/Excellent. Notifications will be sent via email to advise you of your entry status. As a class fills a wait-list will be kept, i.e. entries received after the limit has been reached will be listed in the order received. If an exhibitor cancels an entry no later than the closing date listed the first entry on the wait-list will be contacted no later than Monday, February 15, 2016. Confirmation of entry: You will receive a confirmation email that your entry has been received and accepted. If you do not receive an email confirmation within 2 weeks of sending in an entry please contact us at [email protected]
Cancellation of Entry: Requests to cancel an entry will be allowed up until the closing date and time, Friday, February 5, 2016 at 4:00 p.m. Eastern Time. You may cancel your entry via email sent to [email protected]
or by fax at (919) 816-4204. Refunds for cancellations will be made within 45 days after the closing date for the event. Changes to entry forms: Changes, additions or corrections to entry forms must be received in writing prior to the close of entries. Updates are to be sent to [email protected]
Bitches in Season: Are not permitted to compete in Rally Events. Refunds will be processed if the Event Secretary is notified no later than one half hour prior to the start of judging. Veterinarian statements must be provided to the Event Secretary in writing. They may be hand delivered at the event, emailed to [email protected]
or faxed to (919) 816-4204. Entry Fees: Entry fees are required with each entry. NO ENTRY FEE will be refunded if the trial cannot open or be completed by reason of riots, civil disturbances, fire, an act of God, public emergency, act of a public enemy, or any other cause beyond the control of the organizing committee. No entry fee will be refunded in the event a dog is absent, disqualified, excused by a judge or veterinarian, or barred from competition by the action of the Event Committee. There will be no refund for duplicate entries. All exhibitors should obtain a copy of the Rally Regulations by downloading them from the American Kennel Club website at http://www.akc.org/rules/. ®
AKC RALLY NATIONAL CHAMPIONSHIP SOUVENIRS Watch the AKC Rally® National Championship website listed below for the AKC Rally® National Championship souvenirs. All items will have AKC Rally® National Championship logo. All ordered must be picked up at the event. No orders will be shipped. AKC Rally National Championship
HOST HOTEL Once this information is available it will be posted on the AKC National Obedience Championship website. AKC Rally National Championship
HOST RV ACCOMODATIONS If you are interested in reserving an RV space, please contact the RV Park at Expo Square directly, 918-744-1113, ext. 2154. RV parking with full hookup is available. www.exposquare.com Click on the above link, then Facilities, then RV Park
ADDITIONAL SITE INFORMATION Exhibitors are responsible for cleaning up after their dog(s) at the show site and hotels. Any exhibitor failing to do so may be asked to leave the show grounds without benefit of refund if the Event Committee deems the exhibitor to be in violation of this requirement. Cleaning supplies and disposal sites will be available at various locations around the show grounds.
OTHER EVENT ACTIVITIES Three days of action packed competition as the AKC Rally® National Championship is held in conjunction with the AKC National Agility Championship and the AKC National Obedience Championship. Vendor Booths packed with everything for dogs and their owners. AKC Booth for information on how to register your dog and to encourage dog owners who want to become involved in the World of AKC Events. And much, much more!!
VOLUNTEERS NEEDED If you, your family and/or friends would like to volunteer to work in the rings at this year’s AKC Rally® National Championship or the AKC National Obedience Championship, please complete the form found online at the link below. The deadline to submit your request to volunteer is Friday, January 29, 2016. Volunteer and enjoy the best seat in the house! Submit information online at the following link and click on Volunteer Form: AKC Rally National Championship
INFORMATION TO COME Please check the AKC Rally® National Championship webpage for updated information as it becomes available:
Souvenirs Award Donations Hotel Information Travel Discounts AKC Rally National Championship
IMPORTANT DATES TO REMEMBER!!
Monday, December 28, 2015 o Entry forms will be accepted beginning at 10:00 a.m. Friday, January 29, 2016 o Award Sponsorships are due o Catalog/Well Wishers ads are due o Volunteer Forms are due o Title Updates are due for the printed catalog Monday, February 1, 2016 – Monday, February 29, 2016 o Stall Rentals select online their stall space from those available. Friday, February 5, 2016 o Entries Close
STALL RENTALS The cost of renting a 10’ x 10’ box stall for the weekend (Thursday afternoon through the end of the show on Sunday) is $125.00. The stalls are in a heated building with a concrete floor. The building has large roll-up doors that can be left open if the weather is warm or closed if it is cold. The sides of the stalls are solid on the bottom with bars on the top. Many exhibitors choose to share stalls; that is fine. The stalls are located in the The fee may be paid either by check, money order, or by credit card. A stall rental agreement may be downloaded from: 2016 Stall Rental Agreement. Please remember to sign the Stall Rental Agreement (and the credit card authorization portion, if you are paying by credit card) prior to submitting your form. We are not able to process your rental request unless the form is signed. Once your rental request is processed, an email confirmation will be sent to the email address you list on the rental form confirming your stall reservation. STALL RENTAL RULES: 1. Renter is responsible for the clean-up and removal of trash from their stall area and for keeping the stall area neat during the event. 2. Nothing may be attached to walls of the stalls. Signs/banners may be attached to the bars of the stalls as long as the renter removes all signs (and tape, zip-ties, etc.) prior to vacating the stall. The Renter is financially responsible for any damage to the stall, including the fees from the facility for removing tape, stickers, signs, etc. that were left in the stalls. 3. Stalls must be vacated no later than 1 hour after the end of the event. 4. All dogs must be in either a crate or ex-pen when left unattended in the stalls. 5. If there is an electrical outlet available, renter is allowed to plug in only one electrical device per stall. The electrical device may not exceed a 15 amp. draw. 6. No smoking, heating devices, coffee pots, hot plates, or open flames are permitted in the stall area. 7. Stalls will be pre-assigned. 8. No refunds will be issued on stall rentals. If an exhibitor is unable to attend the event or otherwise use the stall that they have rented, the stall may be sublet to another exhibitor if so desired. The new tenant is also bound by this rental agreement. 9. No reservations will be taken over the phone, nor will a reservation be accepted without the necessary form(s) and fee(s). 10. AKC reserves the right to inspect any stall at any time. **NEW** IMPORTANT – All stall renters will select their stall space location from an online system mapping which spaces are available between February 1st at 8:00 a.m. Pacific and February 29th at 5:00 p.m. Pacific. Those who wish to have stall spaces next to each other must select one representative who will select all stall spaces within their group at the same time. Stall renters who have not selected their space by February 29th at 5:00 p.m. Pacific will be assigned a random space from stalls remaining available. Stalls will be located in the Oklahoma Ford Dealers Barn. A map displaying the buildings and their relation to each other may be viewed at the web site listed below. www.exposquare.com Click on Grounds Map RETURN CONTRACT WITH FEE TO: American Kennel Club Attn: Companion Events – Stall Rentals PO Box 13274 Las Vegas, NV 89112
STALL RENTAL INQUIRIES: Steve Herwig [email protected]
Make checks or money orders payable to: AKC Obedience/Rally Nationals You may fax the stall agreement to: (919) 816-4233 (available for credit card reservations only) All stall rental requests must be received no later than Monday, January 25, 2016
“LIKE” US ON FACEBOOK! https://www.facebook.com/groups/1638620296384046/ Come join in on the online fun as we count down towards a spectacular weekend!!
BE “IN-THE-KNOW” Don’t miss a thing about the upcoming event? You can constantly be In-The-Know!!! All you have to do is opt in to receive informational text messages from AKC regarding the event. Know when new items are posted to the Nationals website, reminders when deadlines are coming due, and last-minute information during the event weekend, in order to opt in text @akcno to (919)261-3556.
SUPPORT THE SPORT BY SPONSORING AN AWARD We welcome your support for awards at the 2016 AKC Rally® National Championship or the AKC National Obedience Championship. To see a complete list of awards being offered please visit the event webpage at, AKC Rally National Championship. All donations will be published on the webpage. All donations received by Friday, January 29, 2016, will be published in the commemorative catalog. ®
AKC RALLY NATIONAL CHAMPIONSHIP AWARDS All participants will receive a Participation Certificate Final Placements are based on cumulative scores and times to determine placements and will be awarded in the Rally Novice, Rally Advanced, Rally Excellent and the RAE classes at the conclusion of the event. Rally Novice Class 1st – 4th Place ~ Trophy & Rosette 5th – 10th Place ~ Rosette
RAE Class 1st Place ~ AKC Rally® National Champion Crystal Star Trophy Commemorative Plaque Placement Medallion Rosette
Rally Advanced Class 1st – 4th Place ~ Trophy & Rosette 5th – 10th Place ~ Rosette
2nd Place Commemorative Plaque Placement Medallion Rosette
Rally Excellent Class 1st – 4th Place ~ Trophy & Rosette 5th – 10th Place ~ Rosette
3rd Place Commemorative Plaque Placement Medallion Rosette 4th Place Commemorative Plaque Placement Medallion Rosette 5th – 10th Place Rosette
IMPORTANT NOTICE TO ALL EXHIBITORS PLEASE READ THE ENTIRE SECTION CAREFULLY EXHIBITOR CHECK-IN: Exhibitors will be allowed to check-in and set-up beginning on Thursday, March 17th. At check-in you will receive your armband, an event catalog and an event souvenir bag at check-in. Once the time and location for check-in is determined all exhibitors will be notified by email. If you are unable to check-in on Thursday, you must check-in at the Secretary’s Table by 7:30 a.m. Friday morning.
Exhibitors MUST check-in at EACH ring, EACH day. LIMITED CRATING: Each dog entered in the event will be allotted one 3’x5’ space. Un-entered dogs will only be allowed in the facility if they can share the crate with an entered dog, or if their crate can be stacked on top of an entered dog’s crate within the 3’x5’ space allotted. Overflow crating, if needed, will be in an adjacent arena. The overflow crating is not climate controlled. Soft sided crates are permitted. A “crate” is defined as having a top, bottom and 4 walls, all interconnecting, thus preventing the dog from escaping. Each exhibitor will be required to display an information card on the outside of each crate; card(s) will be supplied at check-in. The information card must have your name and on site emergency contact information. Dogs cannot be left in the building overnight. NO EX-PENS will be allowed in the facility. No dogs are permitted to be crated or groomed on any carpeted area. ALL DOGS MUST BE ON LEASH: Dogs must be on leash, held by the handler at all times while on the trial grounds except when in the designated warm-up area or competing in the ring. Dogs may NOT be on retractable leads or long-lines while inside the building. Failure to maintain control of a dog may result in an Event Committee hearing. SPECIAL TRAINING COLLARS ARE PROHIBITED. WARM-UP RING: If entries allow enough space a warm-up ring will be provided for dogs entered in the AKC Rally® National Championship ONLY on Friday, no exhibitors are allowed to use the ring without AKC Staff in the building. In accordance with the Rally Regulations, Chapter 1, Section 28. This ring will be monitored and if there are any problems, the ring will be closed. Exhibitors will be respectful of each other. CATALOGS: All exhibitors will receive a complimentary copy of the commemorative catalog in their check-in packet. Limited additional copies may be purchased at the event. SAFETY, BEHAVIOR and LIABILITY: The safety of the dog is our primary concern. By entering this trial, exhibitors acknowledge that they are familiar with the rules and regulations of the AKC. It is expressly understood that exhibitors alone are responsible for the behavior of their dogs and/or children. Any exhibitor whose dogs and/or children create an unnecessary disturbance or repeatedly engage in unsafe or disruptive behavior, may, at the discretion of the Event Committee, be asked to leave the show site. In such cases, no refund of any fees paid will be made. The American Kennel Club and its agents, employees, etc., will assume no responsibilities for any loss, damage or injury sustained by exhibitors or handlers, or to any of their dogs or property and further assumes no responsibility for injury to children. The American Kennel Club reserves the right to decline entries for cause and may remove any dog on account of aggression. No one shall have any recourse or claim against the American Kennel Club or any official thereof. This club agrees to arbitrate claims as set forth on the Official AKC Rally® National Championship Entry Form for this event.
DIRECTIONS TO THE TRIAL SITE The main entrance to the Central Park Hall at Expo Square is located one block west of the corner of 21st and Yale, at 4145 E. 21st Street, Tulsa, OK 74114 From Muskogee (Hwy. 51 Westbound Muskogee Turnpike) Exit Hwy. 51 at Yale Ave., at exit ramp, turn West (left) on 31st St., at first light, turn North (right) on Yale, turn West (left) on 21st or 15th St. From Stillwater (Hwy. 51 Eastbound) Hwy. 51 turns into Hwy. 412 and then Hwy. 244, exit Hwy. 244 at Yale Ave., at exit ramp, turn South (right) on Yale, turn West (right) on 21st or 15th St. From Oklahoma City (I-44 Eastbound Turner Turnpike From I-44, exit at Yale Ave., North (left) on Yale to 21st St.; turn West (left) on 21st or 15th St. From Hwy. 244 Eastbound Exit at Yale Ave., at exit ramp, turn South on Yale, turn West (right) on 21st or 15th St. From Joplin (I-44 Westbound Will Rogers Turnpike) From I-44, exit at Yale Ave., North (right) on Yale to 21st St., turn West (left) on 21st or 15th St.
CATALOG AND WELL WISHERS ADS CATALOG ADVERTISEMENTS Advertisements in the 2016 AKC Rally® National Championship/AKC National Obedience Championship catalog are WELCOMED! This year's exhibitor's catalog will be 8.5 X 5.5 inches, allowing a full-page ad area approximately 4.5 X 7.5 inches to post your message and/or picture. Camera ready ads are accepted in high-resolution press quality PDFs (preferred). JPEG or TIFF files are also acceptable (minimum 300 pixels/inch). If you are sending photos separately, the photos should be scanned to a finished size and at a minimum of 300 pixels/inch. Do not forget to include the correct orientation. Full page ads MUST be in a portrait orientation, and half page ads MUST be in a landscape orientation. If mailing, please send only high quality photos for scanning purposes. Photos will be in black and white. Full page ad up to 4.5” X 7.5”……. $ 80.00 1/2 page ad up to 4.5” X 3.5”…… $ 55.00 WELL WISHERS Send brief good luck wishes from you and/or your club. For $25.00 you can advertise to wish whoever “Good Luck” at the event. The catalog width will be 4.5 inches. The statement must be 25 words or less. PAYMENT You may pay by check, money order or credit card. By submitting a photo and payment for a space, you attest that you are the author and/or copyright holder of the photograph. AMERICAN KENNEL CLUB Attn: Lisa Strickland ~ RNC/NOC Catalog 8051 Arco Corporate Drive, Suite 100 Raleigh, NC 27617-3390 919-816-3816 [email protected]
Deadline for submission is Friday, January 29, 2016 Make checks payable to: AKC Rally® National Championship IF PAYING BY CREDIT CARD, COMPLETE THE FOLLOWING: [ ] M/C [ ] VISA [ ] AMEX [ ] DISCOVER
PLEASE PRINT CLEARLY Name as it appears on Card: PLEASE PRINT Card Number:
Signature of Cardholder: Address: City, State, Zip Code Phone Number: Email Address: (You will receive a confirmation email confirming your order at this address, so please be sure it is one that you check regularly.) You may fax this order form to: (919) 816-4204, Attn: Lisa Strickland