ABGA Judges’ Education Mentor Application

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An applicant must meet ALL of the following criteria in order to receive approval to be an ABGA Judges' Education Mentor.

1. Been an ABGA member in good standing for a minimum of 10 years.

2. A minimum of 12 years experience breeding, exhibiting or judging Brussels Griffons in conformation.

3. Bred and raised 5 or more litters of Brussels Griffons on your own (the applicant's) premises.

4. Bred 10 or more champions from the litters whelped on the applicant’s premises (whether or not owned or handled by the applicant).

5. Attended the complete Brussels Griffon Judges Seminar at the annual National Specialty (not regional) presented by the ABGA inclusive of viewing the Judges Education DVD.

If an applicant does not meet all criteria or is denied by the ABGA Board of Directors, one year must elapse from the Board decision date before another application can be submitted. Submission of this application does not guarantee approval.

Member Information

Date*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Phone*

Is the phone # home or cell?*

Home phone
Cell phone

Fax #

Are you currently a member in good standing with ABGA?*

Yes
No

How many years have you been an ABGA member in good standing?*

Have you ever been suspended from your privileges of ABGA?*

Yes
No

Have you ever been suspended from your privileges of AKC?*

Yes
No

All of the questions below must be answered. If the question does not apply, please indicate N/A.

Please indicate the number of Brussels Griffons you own/co-own*

Number of years you have owned/co-owned Brussels Griffons*

How many years have you exhibited?*

How many litters of Brussels Griffons have you bred and raised on your premises?*

How many Brussels Griffon champions have you bred or co-bred?*

How many Brussels Griffon champions have you personally finished?*

How many ABGA National Specialties have you attended?*

How many ABGA Roving Specialties have you attended?*

How many supported entries have you attended?*

Number of seminars or workshops or judges breed study groups attended on the Brussels Griffon?*

Have you viewed the AKC Brussels Griffon DVD?*

Yes
No

List any sanctioned Sweepstakes/Futurities (S&F)/Specialty Matches (SM)/Fun Matches (FM)/Non-Regular Classes (NR) where you have judged Brussels Griffons*

Please indicate type of event next to each on your list.

List the registered names and numbers of five Brussels Griffons you have owned or co-owned:*

Registered Name:	Litter registration #:

Indicate five litter numbers and whelp dates of Brussels Griffon litters bred on your premises.*

Litter #	Date of whelp:

Indicate the registration # and registered name of four Brussels Griffon champions of which you are the breeder of record.*

Registration #	Registered Name

List Brussels Griffon Specialty Shows/Supported entries you have attended: Date Show Indicate Specialty/Supported Entry*

Show date:	Specialty or Supported Entry

List parent clubs, local or regional clubs of which you are a member and any office held:

Club years:	Office years:	Seminar presenter/workshop group

Have you ever given or assisted in a breed presentation or acted as an AKC mentor in Brussels Griffons? In other breeds?*

Yes
No

If you answered "Yes" to the question above, please provide details, date(s) and or breed(s)

Date:	Breed:	Location:

Feel free to give specific information NOT asked for on this form that you believe documents your general background in the Brussels Griffon breed.

ABGA Judges’ Education Mentor Application

Member Information

All of the questions below must be answered. If the question does not apply, please indicate N/A.

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