Registered Champion Certificate Entry Form

Please type or BLOCK-LETTER the following spaces so that we will get your name, etc., correct. Forms also available on line at www.ifpigeon.com

I,  of   Street, City of   and State of  Zip  do hereby submit to my Club Secretary for verification and completion of this application for a REGISTERED CHAMPION BIRD AWARD. Banded  Name if any  owned and flown by me. Date  Signed  Record of Diploma Performance 

This Entry Form must be signed by the Officer of the Organization you are submitting your race results for!
Combine results submitted; Combine officer’s signature required. Club results submitted; Club officer’s signature required.In a waiver of an officer’s signature please submit the officer contact information and inform him, he will be contacted, in regards to this award

Signature of Club Secretary :   Name of Club :
For official use only :   Address :
City:
State:
Register Number :  Date of Issue : Zip :
  Phone# :

Club Secretary’s Calculation of Points

POSITIONDISTANCE DATESPEEDBIRDLOFTSPOSITION 20 OR LESSDISTANCE 1%BIRD1% TOTAL

   RETURN TO:

   Registered Champion Chairperson

   James Walker

   309 Green Avenue

   Lyndhurst, NJ 07071

   Phone: (201) 939-3142