Lakeland dog training Club AKC All-Breed Agility Trial (Member of the American Kennel Club)

Transcription

1 Premium List Event #s- Saturday ( ), Sunday ( ) Show hours: Saturday and Sunday 7:00am-6:00pm Lakeland dog training Club AKC All-Breed Agility Trial (Member of the American Kennel Club) Open to Dogs Enrolled in the AKC Canine Partners Program. Trial is not open to Doberman Pinschers Saturday, October 6 th & Sunday, October 7 th, 2018 Classes Offered: Saturday-All Levels:, JWW, T2B & Standard Sunday- All Levels:, JWW, T2B & Jumpers It is highly recommended that you reserve hotel rooms early since we are sharing our trial weekend with the World Dairy Expo and a Badger Football game in Madison, and rooms will go quickly. Canine Sports Zone 3036 Laura Lane, Middleton, WI Method of Entry Random Draw Entries limited to 350 runs each day. Entries open Friday, August 3, 2018 at 8:00am. Any entries received before this date will be returned. No Hand Delivered entries accepted until 24 hrs after opening.. Any envelope, mailed or hand delivered, containing more than the ten dog maximum constitutes an invalid entry and will be returned. All express mail must be left with no acceptance signature required. Draw Period Closes: Friday, August 31, 2018 at 5:00 pm Draw: Friday, August 31, 2018 at 7:00 pm Draw Location: 1124 W River Dr, Stevens Point, WI Entries close Friday Sept 23, 2018 at 6:00pm After which time entries cannot be accepted, canceled, altered, or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. AMERICAN KENNEL CLUB CERTIFICATION Permission has been granted by the American Kennel Club for the holding of this event under American Kennel Club Rules & Regulations. James Crowley, Secretary.

2 Mail all entries with fees (check or money order) payable to LDTC to: Lorah Marquardt, Bluestem Agility Trial Services 1124 W. River Drive, Stevens Point, WI Questions Call: (715) Or (preferred): Website: Entry fee of $20.00 for the first entry of each dog per day (includes $3.50 AKC recording fee); $18.00 for second and third entry, $16.00 for fourth entry of the same dog on the same day (includes $3.00 AKC recording fee). WAIT LIST FOR WITHDRAWN ENTRIES: A Wait List of a maximum of 25 entries will be maintained to fill openings created by entries withdrawn after the closing date. All entries, including wait listed entries, must be received prior to the closing date. Written notice to withdraw an entry must be received by the Trial Secretary no later than 6pm on Monday, Oct 1, If a withdrawn entry is replaced by a wait listed entry, a full refund will be issued for the withdrawn entry. Any wait listed entry that does not move off the wait list into the trial, will receive a full refund. VOLUNTEER WORKER SIGN-UP Lakeland Dog Training Club Agility Trials run best with plenty of volunteers. Lunch, snacks and beverages will be provided for workers only. Online worker sign-up will be available. Please send this form only if you do not have internet access Name: Address: (if no ) Phone: Check classes you would be willing to work in and jobs you would be willing to do. See premium for class order. LAKELAND DOG TRAINING CLUB OFFICERS President: Mary Graber Treasurer: Louisa Murphy Vice President: Elaine Burkhart Secretary: Inge Suchanek Board Member: Julie Beich 9203 N. Bowers Lake Road Incoming Board Member: Bob Smith Madison, WI EVENT COMMITTEE Event Chair: Julie Beich, 5114 Buterfield Dr, Madison WI 53704, (608) , amjbeich@sbcglobal.net Members: Julie Beich, Kim Keen, Mary Graber, Cynthia Lord, Sue Heidrich Volunteer Coordinators: Robert Smith, rwsmith1@wisc.ed TRIAL JUDGE: Class: Sat Sun Mas/Exc Std Open Std Novice Std Std XX Mas/Exc JWW 16-4 Open JWW Novice JWW JWW XX Time 2 Beat Job: Sat Sun Course Builder Timer Scribe Gate Steward Ring Crew Scribe Sheet Runner Leash Runner Joan Mullen, W186 N7064 Marcy Road Menomonee Falls, WI jmullen5@live.com Thanks for volunteering Your help is greatly appreciated! Contact volunteer coordinator Mary Graber rwsmith1@wisc.ed with any questions.

3 AKC AGILITY MOVE-UP FORM MOVE-UP REGULATIONS: If a dog earns an AKC agility title before this event, it can be advanced to the next level of competition. However, written notice must be given to the Trial Secretary no later than 6pm on Monday, Oct 1, Day to day move-ups will be accepted if received before the close of the trial Saturday, Oct 6, Trial close will be considered to be the awarding of ribbons for the last class on that day. Move-ups will be added to the end of the running order of the class they move up to and every effort will be made to accommodate handlers running multiple dogs in the same class. Move-up form must be submitted Verbal requests will not be accepted. Fill out each change and send to the Trial Secretary s home address. ed requests accepted as long as all information is included AKC Registered Name: AKC Registration #: Breed: Call name: Owner(s): Days Move-up requested for: Height Division: Move to: Open Exc Mas Pref Move to: Open P Exc P Mas P JWW Move to: Open Exc Mas JWW Pref Move to: Open P Exc P Mas P RUNNING ORDER: Saturday 7:00 am Check in 7:45 am Briefing and Walk-throughs 8:00 am Judging begins Mas/Ex Jumpers Time 2 Beat Standard Mas/Ex Standard Open Standard Novice Standard Open Jumpers Novice Jumpers Small to Tall Sunday 7:00 am Check in 7:45 am Briefing and Walk-throughs 8:00 am Judging begins Jumpers Mas/Ex Jumpers Time 2 Beat Mas/Ex Standard Open Standard Novice Standard Open Jumpers Novice Jumpers Small to Tall Building opens at 6:30 am on Sat and Sun. SITE INFORMATION: All classes will be held in a heated building on field turf with rubber infill. Ring size: 117 ft x 86 ft. Exhibitors and spectators are expected to keep the entire area clean. Anyone witnessed not picking up after their dogs on the trial grounds will be excused from the trial with no entry fees refunded. CRATING: There is plenty of crating at this site, please bring a ground cover for under your crates. The crating area is climate controlled. Crates may be left overnight; however, Lakeland Dog Training Club, Canine Sports Zone and Bluestem Agility Trial Services, LLC will not be responsible for any lost or damaged items left at the show site. Dogs may not be left overnight. PARKING: There is ample parking available. RV overnight parking is available at the trial site. Cost for motorhomes/campers $10 per night for no electrical hookups. $25/night for electrical hookups. Electrical hookups are limited and are by first request/payment basis. Please to check availability & hold: Jessica@CanineSportsZone.com. Checks payable to Canine Sports Zone. CATALOGS: Running orders will be available online. Full catalogs will be available for sale for $10 on the day of the trial, but supplies will be limited. Advanced catalog sales $7. PRIZES AND AWARDS: Qualifying ribbons will be awarded to those dogs receiving qualifying scores. Rosettes will be awarded for first through fourth place in each jump height division for Excellent, Novice and Open levels. New title ribbons, double Q ribbons and MACH & PACH rosettes and bars will also be awarded. Prizes must be claimed the day of the show -- none will be mailed FOOD: Food and beverages will be provided for workers. Food for non-workers will not be available for purchase. There are many restaurants within 5 minutes of the show site.

4 JUMP HEIGHT DIVISIONS: REGULAR PREFERRED HEIGHT AT WITHERS Dogs may be run in a higher height Dogs must run in their proper Owners are responsible for entering their dog in the proper height division. division. eligible height. 8 4 For dogs 11 inches and under at the withers 12 8 For dogs 14 inches and under at the withers For dogs 18 inches and under at the withers For dogs 22 inches and under at the withers For dogs over 22 inches at the withers 24C n/a Dogs measuring 22 inches and under at the withers may enter the 24-Choice height division. Dogs who measure into the 24 regular jump height division may not enter 24-Choice. HEIGHT CARD REQUIREMENT: When filling out the entry form, please designate whether your dog has a valid jump height card or if your dog needs to be measured. Please check the appropriate box so that the Trial Secretary knows whether to include your dog on the list of dogs to be measured. If a measurement is necessary, it is solely the exhibitor s responsibility to have their dog measured prior to running. Exhibitors should have their dog s original, official jump height card or temporary jump height form available at each trial to present upon request. Regulations for Agility Trials, Chapter 2, Section 4. REFUNDS: No entry fees will be refunded if the trial cannot open or be completed by reason of riots, civil disturbances, fire, act of God, public emergency, act of a public enemy, or any other cause beyond the control of the organizing committee. Entry fees shall not be refunded in the event that a dog is absent, disqualified, excused by a judge, or barred from competition by action of the Trial Committee. Entry fee for bitches that come into season or a dog that is injured after the closing date will be refunded (less $12 administrative fee per day) if a veterinarian s certificate is presented to the Trial Secretary 30 minutes prior to the start of judging. OBSTACLES: Obstacles will meet the specifications in the current edition of the Regulations for Agility Trials. DOGS ELIGIBLE TO ENTER: This trial is open to all dogs 15 months of age or older that are registered with the American Kennel Club, or are registerable breeds that have obtained an AKC, ILP or PAL number. Bitches in season, aggressive, blind or deaf dogs or dogs suffering from any deformity, injury or illness which may affect the dog s physical or mental performance are ineligible to participate. Mixed breed dogs that have been listed with AKC Canine Partners may participate provided their listing number has been recorded on the entry form and the trial-giving club is offering the optional mixed breed classes. Doberman Pinschers are not eligible to enter. RINGSIDE: Dogs are not required to be at the trial until the scheduled time of judging. All dogs not needed for further judging are excused. The owner or handler of each dog is solely responsible for having the dog ready at ringside when the class is to be judged. Please help your fellow competitors, the trial workers, and the judge by checking in with the gate steward well ahead of your turn, and being prompt at the line when your turn comes to run. SAFETY AND BEHAVIOR: The safety of the dogs is our primary concern. By entering this trial, exhibitors acknowledge that they are familiar with the rules and regulation of this sport and that their dogs are familiar with and able to perform all obstacles safely. Exhibitors should follow their veterinarians recommendation to assure their dogs are free of internal and external parasites, any communicable diseases, and have appropriate vaccinations. LIABILITY: 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 unnecessary disturbances or repeatedly engage in unsafe or disruptive behavior may, at the discretion of the Trial Committee, be asked to leave the show site. In such cases, no refund of any fees paid will be made. ABMC, Bluestem Agility Trial Services, LLC, and their members, agents, etc. will assume no responsibility for any loss, damage or injury sustained by exhibitors or handlers, or to any of their dogs or property, and further assume no responsibility for injury to children. HOTEL INFORMATION: It is highly recommended to reserve hotel rooms early since we are sharing our trial weekend with the World Dairy Expo and a Badger Football game in Madison, and rooms will go quickly. The following area hotels accept well-behaved people and their pets. Exhibitors must contact hotels directly and identify themselves as having dogs. Some of these hotels do charge an extra fee for dogs. Be sure to verify the dog policy with the hotel of your choice when you make your reservation. Please be a responsible owner and a considerate hotel guest by maintaining a restful atmosphere and cleaning up after your dog. Baymont Inn & Suites, 8102 Excelsior Dr Madison, WI (608) We have reserved a block of rooms for the trial weekend (10/5 and 10/6). Rooms will be available for $ per night with no extra dog fees. Mention Lakeland Dog Training Club when reserving your room. Block of rooms will be held for us until September 5, so please reserve your room early. Comfort Suites, 1253 John Q Hammons Drive Madison, WI La Quinta Inn & Suites, 5217 East Terrace Drive Madison, WI Staybridge Suites, 7790 Elmwood Avenue Middleton, WI DIRECTIONS: Canine Sports Zone 3036 Laura Lane,Middleton, WI (GPS Coordinates: 43 06'25.3"N 89 30'52.2"W) ' From the North: Take the US-12 south toward Madison. Take the Airport Rd exit (EXIT 250) toward Century Ave/County Hwy M. Turn left onto Airport Rd. Turn right onto Laura Ln. Continue to 3036 Laura Ln on the right. From the South: I-90 W toward Rockford/ I-294 N/Milwaukee. Merge onto US-12 W/W Beltline Hwy W via EXIT 142A on the left toward Madison. Take the Parmenter St exit, EXIT 251B. Enter the US-12 Bus E/Parmenter St roundabout. Turn slight right onto Parmenter St/US-12 Bus W. Turn left onto Donna Dr (Culver s). Turn right onto Laura Ln Laura Ln is on the left. From the East: From Milwaukee take I-94 West. Keep left to take WI-30 toward Madison/Janesville. Merge onto US-12 W/W Beltline Hwy W via EXIT 142A toward Madison. Take the Parmenter St exit, EXIT 251B. Enter the US-12 Bus E/Parmenter St roundabout. Turn slight right onto Parmenter St/US-12 Bus W. Turn left onto Donna Dr (Culver s). Turn right onto Laura Ln Laura Ln is on the left. VETERINARIAN ON CALL: Veterinary Emergency Service 1612 N. High Point Rd Ste 100, Middleton, WI (608)

5 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Lakeland Dog Training Club October 6 & 7, 2018 Opens: 8/03/2018 Draw 8/31/2018 Closes: 9/22/2018 SATURDAY JWW T2B SUNDAY N/A JWW Entry Fee: $20 first run, $18 second and third runs, $16 fourth run. Checks payable to: LDTC Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (, JWW, FAST, T2B) REGULAR Classes C NovA JWW NovA FAST NovA T2B T2B NovB Open Exc Master NovB Open Exc Master NovB Open Exc Master N/A PREFERRED Classes NovP OpenP ExcP MasterP P JWW NovP OpenP ExcP MasterP P FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes JWW This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS Enter Complete Registration # below DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this event, and any additional rules and regulations appearing in the premium list of this event and entry form and any decision made in accord with them. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, directors, governors, officers, agents, superintendents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other person. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. INSTRUCTIONS Handlers whose dogs measure into the 8 through 20 regular jump height divisions may opt to enter in a higher or 24-choice height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs who measure into the 24 regular jump height division may not enter 24-choice. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner? SIGNATURE of owner or his agent duly authorized to make this entry.. SIGN HERE X Telephone Number: Exhibitor or owner MUST sign on the signature line beneath the instructions. Address: In Case of Emergency - Name: Phone #: (OPTIONAL) New AEAGL2 (10/17)

6 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Lakeland Dog Training Club October 6 & 7, 2018 Opens: 8/3/2018 Draw 8/31/2018 Closes: 9/22/2018 SATURDAY JWW T2B SUNDAY N/A JWW Entry Fee: $20 first run, $18 second and third runs, $16 fourth run Checks payable to: LDTC Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (, JWW, FAST, T2B) REGULAR Classes C NovA JWW NovA FAST NovA T2B T2B NovB Open Exc Master NovB Open Exc Master NovB Open Exc Master N/A PREFERRED Classes NovP OpenP ExcP MasterP P JWW NovP OpenP ExcP MasterP P FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes JWW This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS Enter Complete Registration # below DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this event, and any additional rules and regulations appearing in the premium list of this event and entry form and any decision made in accord with them. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, directors, governors, officers, agents, superintendents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other person. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. INSTRUCTIONS Handlers whose dogs measure into the 8 through 20 regular jump height divisions may opt to enter in a higher or 24-choice height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs who measure into the 24 regular jump height division may not enter 24-choice. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner? OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable SIGNATURE of owner or his agent duly authorized to make this entry.. SIGN HERE X Telephone Number: Exhibitor or owner MUST sign on the signature line beneath the instructions. Address: In Case of Emergency - Name: Phone #: (OPTIONAL) New AEAGL2 (10/17)