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Type your "V" application information in the fields below and then select "print" from your browser.  Send this application and worksheet (Adobe PDF) along with verification of titles (photocopies of title certificates, AKC Gazette pages listing titles or AKC report available from their on-line store) to: Kari Lavalli, 4 Pleasant St, Blackstone MA 01504.  DO NOT send original title certificates as they can not be returned.  If you have any questions, email Kari Lavalli.  Thank you.

Versatility award applications are processed quarterly.  The schedule is: January, February, March processed the first week of April; April, May, June processed the first week of July; July, August, September processed the last week of September; October, November, December processed the first week of January.

(R) = Required Information

BCSA Member's Name:   (R)
Street Address:   (R)
City:    State        Zip:      (R)
Home Phone:   (R)  Work Phone:
Dog's Registered Name
(including titles):
Dog's Information:

Note: Dog must have valid OFA/CERF numbers or be spayed/neutered.
OFA#:   CERF #:  

Name of Actual Owner:   (R)
Member's Signature: ___________________________________________________  Date:   (R)

Please note: This is the application for the "V" Award.  It may not be used for the VX or VCH award.  All Versatility awards issued after Nov. 2, 2000 must use this application form/worksheet and are subject to the revised requirements.  Applications on old forms will not be honored.

Page Updated 09.13.2015