Dog Breeders
Membership Application

(Please complete all fields. Thank you.)

First Name:*      Middle Initial:    Last Name:*  

Address:*  

City:*        State/Province:*       

Zip:*  

Country:*    

First Phone*        Cell Phone:*  

Email Address:*  

Kennel Name:

Kennel Website:*  

Dog Breed or Breeds You Breed?*

Do you belong to a breed or kennel club?*
Yes        No

If so, which one(s) are your dogs registered under?*

Do you provide your puppy buyers with registration applications?*
Yes        No

If so, which one(s) ?*

Do you provide a written bill of sale and/or contract defining the responsibilities of buyer and seller?*
Yes        No

Do you perform appropriate health screens on sire and dam prior to breeding.*
Yes        No

If so, which one(s) ?*

How many years have you been breeding dogs?  

Please list any other relevant information you would like to share about your breeding practices.