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National Kennel Club
APPLICATION TO REGISTER A PUREBRED DOG
(PLEASE PRINT NEATLY)

NAME OF DOG
BREED    SEX  
DATE OF BIRTH         COLOR AND MARKING  
OWNER OF SIRE        OWNER OF DAM         
WAS THE DOG PREVIOUSLY REGISTERED?  IF YES, WHICH REGISTTY? 
INSPECTED BY DATE   
    SIRE  
  SIRE  
    DAM 
SIRE     
    SIRE   
  DAM    
    DAM 
    SIRE  
  SIRE    
    DAM  
DAM     
    SIRE  
  DAM   
    DAM 

I CERTIFY THAT I AM THE OWNER OF ABOVE DOG AND THAT THIS INFORMATION IS TRUE.

OWNER   SIGNATURE
ADDRESS   3059 Brandau Road  /  Hermitage, Tennessee     37076-3502
TELEPHONE: (AREA CODE)        (615)    885 - 7736
WITNESS  WITNESS 

FEE: THREE GENERATION PEDIGREE: $13.00

ADD $5.00 FOR OUT OF COUNTRY CHECK OR MONEY ORDER (BANK REGULATION)

FOR RUSH SERVICE: ADD $5.00. IF DESIRED, CHECK HERE ________

OPTIONAL ENTRY ENTRY CARD $5.00