Individual Dog Registration Form

Dog's Name*

Gender*

Male
Female

Dog's Date of Birth*

Date of Purchase

Country of Birth

Recognized Working Titles

OFA# and rating or “a” Stamp rating

Breed Survey

Show Rating

AKC Registration #

SV Registration #

Other Registration #

Type of Coat

Colors and Markings

Name of Breeder

Sire Information

Name of Sire

USA Reg. #

AKC Reg. #

SV Reg. #

Other Reg. #

Recognized Working Titles

Breed Survey

Show Rating

OFA# and rating or “a” Stamp rating

Dam Information

Name of Dam

USA Reg. #

AKC Reg. #

SV Reg. #

Other Reg. #

Recognized Working Titles

Breed Survey

Show Rating

OFA# and rating or “a” Stamp rating

Owner Information

First Name*

Last Name*

Street Address*

Address 2

City*

State*

Zip Code*

Country*

Member ID*

Co-Owner

Home Phone*

Email

Identification

I certify that I have examined the tattoo of this dog.

Tattoo

All dogs registered with USA are required to have positive identification. If the dog is tattooed prior to registration with USA, the tattoo MUST be verified by a USA Tattooer, USA Breed Warden, Licensed Veterinarian, Member of the USA Breed Advisory Committee or Körmeister. Verification of the identification must be submitted to the USA Office before the pedigree will be issued.

Location of Tattoo

Tattoo / Chip Number

Payment

Individual Dog Registration Fee*

$35

Total Amount:

Price: $0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Authenticity*

I certify that all information on this application is true and correct and that I am the Owner/Co-Owner of the dog on this application.

I understand that any misrepresentation on this application is cause for revocation of the USA dog registration and may result in the loss of all USA privileges which could include expulsion from USA.

I certify that all information on this application is true and correct and that I am the Owner/Co-Owner of the dog on this application. I understand that any misrepresentation on this application is cause for revocation of the USA dog registration and may result in the loss of all USA privileges which could include expulsion from USA.

USA Individual Dog Registration Application

￼￼Sire Information

Dam Information

￼￼Owner Information

￼￼Identification

Payment

Sire Information

Owner Information

Identification