Working Australian Shepherd Club of Upstate New York (WASCUNY)    Record of Merit (ROM) Form

General Instructions:

1. Form must be filled out completely for one dog or one exhibitor per day. Multiple class entries (conformation, obedience, etc.) may be included on the same form for the day, but can only apply to one exhibitor. 2. Form must be received by the ROM Coordinator within 30 days of the show in which the points were earned. Information must be submitted on this form. 3. Send or give completed form to:

Linda Braun 660 Krumkill Road Albany, NY 12203

Dog's Registered or Call Name: ______________________________________________

Owner's Name: __________________________________________________________

Address: _______________________________________________________________

City: __________________________________ State: _____________ Zip: ___________

Show Date: ___________________ Location: __________________________________

Host Club: ______________________________________________________________

Class Entered: ________________________________ Placement: __________________

For performance classes: # in class ______________ Score (if applicable):       _____________

For conformation classes: # puppy dogs/ bitches       _________________/________________

# regular dogs/bitches _________/_________     # special dogs/bitches   _______/_________

Other Awards (List): ______________________________________________________

(Office Use) Points: ____________________________