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Certificate of Conformation Assessment
(CCA) Event Host Club Application  

This form is to apply for CCA event approval. Once approved the events will be submitted to the calendar. The CCA form can be found in PDF format here or you can apply on-line.

Mailing Address:

Robin Bowen
PO Box 884 
Hixson TN 3734
WE THE, (Club)
apply for permission to hold a CCA Event
on - - (month-day-year)  
starting at (time) 
The location for the CCA Event will be .
Entry Fee $
**Limited Entry of Alternates
Website:
Closing Date - - (month-day-year)  
Entries accepted by: 
(other)
*Opening Date - - (month-day-year)  
(*Opening date is optional and if listed then NO entries may be accepted before this date.)
Earliest date this event may be posted to the GRCA Website: - - (month-day-year)  
Additional Information:
EVALUATORS FOR THE CCA EVENT SHALL BE:
Name:
Category 2
Name:
Category 1
Name:
CCA Host Club EVENT Committee Members
(2 of whom shall be GRCA members)
CCA Event Chairman:
CCA Event Secretary:
CCA Event Committee Member:
CCA Package will be sent to Host Club’s Event Secretary
Secretary Name
Email
Phone
Address
Address line 2

City/Town
State/Provence
Zip/Postal Code
Country

I have read and understand the latest revision of the GRCA CCA Program Rules and Regulations and I shall endeavor to have them adhered to and the email address provided acts as an electronic signature..

(Information of person submitting form)

Name
Title
Email
Phone
Date
- - (month-day-year)  

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