Name:

Street Address: (ex: PO Box 11692)

City:

State and Zip Code:

Home Phone Number:

Work Phone Number:

Breed: (if mix or unregistered, specify breed or breed mix. EXAMPLE: unregistered APBT/lab mix)

E-Mail Address:

What Kennel Club is your canine registered with? (N/A for unregistered)

canine's Registration Number: (N/A for unregistered)

canine's Registered name: (N/A for unregistered)

canine's Call Name:

Date of Birth of canine:

Gender of canine:

Sire of the canine you are registering: (N/A for unregistered, if not known)

Dam of the canine you are registering: (N/A for unregistered, if not known)

For dogs already registered with a kennel club, please include a copy of a three generation (or higher) pedigree certificate. You may, at your option, also include a photo of your dog.
For unregistered purebred dogs or mixes, please include 2 photos, one front view and one side view. Make out your check or money order for $15 to: Dawn Capp. Mail to: PO Box 11692, College Station, TX 77842

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