USMRA Judge Certification Program Application

Full Name*

First NameLast Name
Number*
Phone Number*

Area CodePhone Number
Complete Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Preferred Method of Contact*

PhoneEmail
Club*
Qualifications (Dogs trained and titled and/or judgeships in other disciplines):*
References - (Must include a letter of recommendation from your club)
1. Name*

First NameLast Name
Position*
Phone Number

Area CodePhone Number
E-mail
2. Name*

First NameLast Name
Position*
Phone Number

Area CodePhone Number
E-mail
Signature:*
Date*

MonthDayYear
Date
Hard Copies can be sent to: Angie Leonberger, USMRA Secretary, 2406 Pixton Dr, Killeen, Texas 76543 or sec@usmondioring.org
Attachment - Please attach a letter of intent to this document and include a statement that summarizes your motivation for becoming a judge. Also, please attach a copy of the scorebooks for the dogs used as qualifying criteria.

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