OFFICIAL GSMDCA HERDING COMPLAINT FORM Name of Club where test/trial was held:_______________________________________________ Date & Location:______________________________________________________________________ Type of Event: ______________________________________________________________________ Please Print Name of Handler at trial:_____________________________________________________________ Actual Owner(s):______________________________________________________________________ Owner's Address:______________________________________________________________________ City State Zip: ______________________________________________________________________ Telephone # (required): ______________________________________________________________ Breed: ______________________________________________________________________________ Full Name of Dog:_____________________________________________________________________ Registation number:___________________________________________________________________ DATE of Birth: _______________________________________________________________________ Class: Course/Livestock:______________________________________________________________ Chairman of test/trial:_______________________________________________________________ Secretary of test/trial:______________________________________________________________ Judges Name:__________________________________________________________________________ Please enclose $25 which may be forfeited if decision is sustained. Please make check payable to GSMDCA, Inc. Complaint (please be as descriptive as possible, continue on back if needed): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Signature & date _______________________________________________________________ Please submit to GSMDCA Herding Committee with fee within 30 days of original complaint to herding committee where trial was held