LITTER REGISTRATION APPLICATION - United …

1 UKC #_____Was Frozen Semen Used? Yes No Date Collected for Freezing_____Registered Name of Sire _____Sire Registrant/Sole Signatory (Please print)_____Sire Registrant/Sole Signatory Signature (Required)_____Sire Co-Registrant (if applicable, please print)_____Sire Co-Registrant Signature (Required, if applicable)_____Current Address _____City _____State/Province _____Postal Code_____ Country _____Phone # (_____ ) _____Email Address _____LITTER REGISTRATION APPLICATIONP lease allow 4 to 6 weeks for carefully complete this form. UKC is not responsible for errors caused by illegible handwriting. Incomplete applications may resultin processing delays.

2 The LITTER must be registered before it reaches one year of age. Both the Sire and Dam must be permanently registered with UKC in order to register a LITTER . You can register this LITTER online at # Males _____Total # Females _____Date of Breeding_____/ _____/_____Date of Birth_____ / _____ / _____Step 1 - LITTER Information LITTER REGISTRATION Fee: $ Gestation Period is 63 the name of the Registrant/Sole Signatory to whom the LITTER is being registered. _____Signature of the Registrant/Sole Signatory (Required)_____Current Address _____UKC is NOT responsible for undeliverable mail due to incomplete mailing _____State/Province _____Postal Code _____ Country _____Phone # ( _____ )_____ Email Address (Required for Expedited Service)_____ By signing this APPLICATION all the above parties agree to abide by all UKC rules, regulations, and policies; also understand that each are responsible for all information contained herein.

3 All applications become the property of UKC and are not returned. UKC reserves the right to refuse an APPLICATION as well as correct or revoke any REGISTRATION at any to Step 5 For Permanent Registrationof pups, see Step 5. For fees and additional services, see Step 6 Step 2 - Sire InformationStep 3 - Dam InformationUKC #_____Registered Name of Dam _____Dam Registrant/Sole Signatory (Please print)_____Dam Registrant/Sole Signatory Signature (Required)_____Dam Co-Registrant (if applicable, please print)_____Dam Co-Registrant Signature (Required, if applicable)_____Current Address _____City _____State/Province _____Postal Code_____ Country _____Phone # (_____ ) _____Email Address (Required for Expedited Service)

4 _____Complete Step 4 ONLY if the LITTER Registrant/Sole Signatory is not the Registrant/Sole Signatory of the 4 - LITTER Registrant Information- Complete this Step ONLY if the LITTER Registrant/Sole Signatory is not the Registrant/Sole Signatory of the Dam. Revised 2-17 Registrant/Sole Signatory (Only one individual may be listed as the Registrant/Sole Signatory)3-Gen Pedigree ..$24 4-Gen Pedigree ..$29 6-Gen Pedigree ..$45 7-Gen Pedigree ..$60 AdditionalEasy EntryTMCard ..$10 Sex _____ Color_____ Variety _____Tattoo# / Chip Number _____Print the name of the Sole Signatory to whom pup is being registered. _____Address_____City _____State/Province _____ Postal Code _____ Country _____Phone (_____) _____ Email _____ Date of Sale _____ / _____ / _____DogNameStep 5 - Permanent REGISTRATION of PupsBy choosing to permanently register, you must name the puppy, provide the color, sex, and the Registrant/Sole Signatory s name and contact information.

5 If you wish to permanently register 5 or morepups, go to for a special discounted rate for Permanent REGISTRATION of your Day Air(Available for physical mailing addresses in Continental US / Fee for delivery outside the Continental US will behigher. / Saturday delivery not available / No Box addresses.)..$60 Expedited Service (Upon receipt at UKC, processed and returned within five business days, with tracking number. Available in continental US only.)..$40 Rush Service (Processed within five business days of receipt at UKC / does not include time in transit.)..$30 Tube mailing of 6 or 7 Gen Pedigree (option to place pedigree in tube instead of envelope).

6 $15 DNA Services - Used to identify and verify parentage DNA Profiling Kits (Price per Kit) ..$4 DNA Kit & Pre-Paid Profile (Price per Kit & Profile)..$49 Step 6 - Additional Services (Fees are in addition to REGISTRATION Fees and are subject to change without notice)(If more than one individual is being listed on thisdog s record, a Sole Signatory Form is required)Checks and money orders must be payable in US funds and made to the order of: United Kennel Club Attn LITTER E. Kilgore Rd Kalamazoo, MI 49002-5584 Phone: (269) 343-9020 Fax: (269) 343-7037 requesting an accelerated service,write RUSH, EXPEDITED or NEXT DAY AIR on the outside front ofthe envelope.

7 Faxed or emailed applications within the continental US will be charged an EXPEDITEDS ervice Fee of $40. applications outside the Continental US will be charged a RUSH service fee of $ $_____Total from STEPS 5 & 6 .. $_____GRAND $_____Credit Card Information(Major Credit Cards Accepted)Credit Card Number_____Expiration Date _____Cardholder s Name _____Cardholder s Signature _____Billing Address _____City / State / Postal Code_____Email Address_____Phone Number _____Office Use Only Declined Approved Auth # _____Fee_____Init _____In Date _____Ctrl # _____ Ck # _____Step 7 - Payment Information3-Gen Pedigree.

8 $24 4-Gen Pedigree ..$29 6-Gen Pedigree ..$45 7-Gen Pedigree ..$60 AdditionalEasy EntryTMCard ..$10 Sex _____ Color_____ Variety _____Tattoo# / Chip Number _____Print the name of the Sole Signatory to whom pup is being registered. _____Address_____City _____State/Province _____ Postal Code _____ Country _____Phone (_____) _____ Email _____ Date of Sale _____ / _____ / _____DogName(If more than one individual is being listed on thisdog s record, a Sole Signatory Form is required)3-Gen Pedigree ..$24 4-Gen Pedigree ..$29 6-Gen Pedigree ..$45 7-Gen Pedigree ..$60 AdditionalEasy EntryTMCard ..$10 Sex _____ Color_____ Variety _____Tattoo# / Chip Number _____Print the name of the Sole Signatory to whom pup is being registered.

9 _____Address_____City _____State/Province _____ Postal Code _____ Country _____Phone (_____) _____ Email _____ Date of Sale _____ / _____ / _____DogName(If more than one individual is being listed on thisdog s record, a Sole Signatory Form is required)3-Gen Pedigree ..$24 4-Gen Pedigree ..$29 6-Gen Pedigree ..$45 7-Gen Pedigree ..$60 AdditionalEasy EntryTMCard ..$10 Sex _____ Color_____ Variety _____Tattoo# / Chip Number _____Print the name of the Sole Signatory to whom pup is being registered. _____Address_____City _____State/Province _____ Postal Code _____ Country _____Phone (_____) _____ Email _____ Date of Sale _____ / _____ / _____DogName(If more than one individual is being listed on thisdog s record, a Sole Signatory Form is required)$30