Application to Register A Purebred Dog 7-2013

1 National Upland Classic ARHA American Fox Beagle National Kennel club Application to Register A Purebred Dog PO Box 331 Blaine, TN 37709 865-932-9680 865-932-2572 fax PLEASE PRINT CLEARLY AS WE CANNOT BE RESPONSIBLE FOR ERRORS. If a single name dog is listed the owner s last name will be added to the dog. Name of Dog_____ Breed_____ (Do not use over 24 letters and spaces) Sex_____ Date of Birth _____ Color and Marking_____ If your dog was previously registered, attach a copy of the pedigree for verification of breed. If your dog has not been previously registered, then your dog will need to be inspected by either a veterinarian or licensed NKC breed inspector and you will need to send in 2 pictures of your dog (front & side view).

2 Inspected by_____ Title/ License #_____ Date_____ Include NKC # s if available. SIRE_____ SIRE_____ DAM_____ SIRE_____ SIRE_____ DAM_____

3 DAM_____ SIRE_____ SIRE_____ DAM_____ DAM_____ SIRE_____ DAM_____ DAM_____ **If your dog has a micro chip or you have its DNA papers, attach a copy of the records for the registration.

4 ** DNA Number Micro Chip Number Check if new address. I certify that I am the owner of the above dog and that this information is correct Owner (print clearly) _____ Signature_____ Co-Owner Signature Street Address_____City_____ ST Zip Telephone ( ) - Email Address NKC Fees payable in US funds by check, money orders or credit card.

5 Check appropriate box(s) below. For God so loved the world, that he gave his only begotten son, that whosoever believeth in him should not perish, but have everlasting life. John 3:16 *All Faxed and Emailed applications will be charged the Rush Service Fee Effective 8-1-13 $ - Registration Fee for up to 3-Generation Pedigree $ - Basic Registration - Sire & Dam only listed $ - Optional Quick Entry Card $ - Optional Photo Entry Card $ - Optional Rush Service - The rush service only expedites the processing of paperwork through the NKC office. Additional fees required for overnight or priority mail services. Contact the NKC office for these fees.

6 $ - Out of Country Processing Fee Total amount enclosed $ _____Exp Date V code Card Number Card Holder Signature (last 3 numbers in signature panel on back of card)