AKC Patch Program Document Request

Patch Program Request

Instructions: Please include as much information as possible to help us tailor the Patch Program to your event. Once this form is completed, we will direct you to order the patches for your event, the cost of each Patch is $1. Then, we will create the Patch program document and send you a digital copy you can print at your convenience.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address- Please tell us the address where you would like the Patches delivered.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Club Name*
Event Name *
Date

MonthDayYear
Date
How many children are you expecting to participate in this program?*
Select the age range(s) of Patch Program participants:

Kindergarten - 3rd Grade4th grade & Up
Please select ALL of the following that you will feature at your show.*

AKC RallyAKC Scent WorkAgilityBeginner PuppyCanine Good CitizenConformationDock DivingEarthdogFast CATField EventsGrooming TablesHerdingJunior ShowmanshipLure CoursingMeet the BreedsObedienceTrackingTrick DogOther
Please list any questions you would like us to answer.
Should be Empty:

Patch Program Request