LRPappform - IRISH WOLFHOUND HEALTH GROUP

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LONGEVITY RECOGNITION PROGRAMME APPLICATION FORM

If your Wolfhound has already been accepted for the qualification portion of the programme you only need to send proof of the date your wolfhound died to qualify for the Longevity Certificate.

For the veteran list or qualifying in the programme please attach a copy of your Irish Wolfhound’s registration and verification that he/she is still alive:

For the Longevity Certificate please attach a copy of your Irish Wolfhound’s registration and verification of the date he/she died:

Copy of registration

Verification still alive

Verification of date of death

Dog's registered name*

Dog's pet name:*

KC reg no:*

Titles (eg Ch, JW, ShCM)

Dog's date of birth (dd/mm/yyyy):*

Dog's date of death (if applicable):

Name of owner(s):*

Name of breeder(s):*

Address of owner(s);*

Phone no:*

Email:*

Repeat Email:*

Optional photograph:

By submitting this informaiton I/we give permission for it to be published online on the Irish Wolfhound Health Group website (www.iwhealthgroup.co.uk).

I agree

If your message does not send when you click 'send' please check that you have completed all the fields marked with an asterisk.