NATIONAL KENNEL CLUB
PO Box 331
Blaine, TN  37709
REG. U.S. PAT. OFF.

Telephone:  423-932-9680
                  423-932-8907
 

NAME OF DOG_________________________________BREED__________________________SEX___________

DATE OF BIRTH________________________________COLOR AND MARKS____________________________

OWNER OF SIRE_______________________________OWNER OF DAM________________________________

WAS THE DOG PREVIOUSLY REGISTERED?_________WHICH REGISTRY?_____________________________

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 (print clearly)___________________________________SIGNATURE_______________________________

ADDRESS______________________________________________________________________________________
                         STREET OR ROUTE                            BOX NO.                                  CITY                                            STATE                    ZIP

TEL:(                   )______________________

WITNESS_________________________________________WITNESS_____________________________________

FEE:  THREE GENERATION PEDIGREE ...............................................$13.00
          EVENTS ENTRY CARD.................................................................$  5.00

RUSH SERVICE:  ADD $5.00.  IF DESIRED CHECK HERE_______________

_______________________________________________________________________________________________

Breed Inspector:  cut along this line and give to person registering a dog.

I RECEIVED____________DOLLARS FROM__________________________________________________________

REGISTRATION FEE FOR DOG NAMED___________________________________BREED___________________

SIGNATURE OF BREED INSPECTOR______________________________________DATE____________________

YES, NKC STILL PAYS A REWARD OF $100.00 FOR INFORMATION LEADING TO ARREST AND THE CONVICTION OF PERSON OR PERSONS STEALING NKC REGISTERED DOG OR DOGS!!

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