Dog Registration Domestic - American Bully Kennel Club

SINGLE DOG REGISTRATION FORM
DOMESTIC
U.S. Resident
American Bully Kennel Club
Registration Dept.
P.O. BOX 2677
Spotsylvania, VA 22553
Send a copy of the front and inside of your Pedigree Certificate (3 Generations)
for verification of ownership and linage of the dog.
Also include a front and side picture of your dog.
Please see www.theabkcdogs.org for a listing of registries accepted by ABKC.
Please mail all completed documents to the address listed.
ABKC accepts Money Orders, Cashier Checks & Personal Checks made payable to
American Bully Kennel Club. The ABKC now accepts PayPal. Please send a copy of
your receipt in with the application. PayPal address is [email protected]
Fees: $20.00 Per Dog- Domestic (if you live in the U.S)
Processed Date:_______________________________ Bully ID #: ___________________________ ABKC #:_________________________________
Owner Information:
Today’s Date: _______________
First Name: _________________________________________________________ MI: __________ Last Name: __________________________________________________________
Street Address: _________________________________________________ City: __________________________________ State: _______________ Zip: ______________________
Contact #: _______________________________ Alternate #: _______________________________
Email: _________________________________________________________
Has there been a change of address?
YES
NO
Under penalty of perjury, all information provided on this form is true and correct to the best of my knowledge.
x_________________________________________________________________
Owner Signature
Co-Owner Information:
Today’s Date: _______________
First Name: _________________________________________________________ MI: __________ Last Name: __________________________________________________________
Street Address: _________________________________________________ City: __________________________________ State: _______________ Zip: ______________________
Contact #: _______________________________ Alternate #: _______________________________
Email: ____________________________________________________________
Under penalty of perjury, all information provided on this form is true and correct to the best of my knowledge.
x_________________________________________________________________
Co-Owner Signature
Registering Dog Name as Shown on Pedigree (maximum characters 29)
COLOR:
**Breed Applying For
Microchip #
Current Registry
Gender
Date of Birth
Current Registration #
DNA #
Breed Registered As
SIRE Name as Shown on Pedigree (maximum characters 32)
OFFICE USE ONLY
___________________________________________________________________________________________________________________________________________________________
Current Registry
Current Registration #
DAM Name as Shown on Pedigree (maximum characters 32)
______________________________________________________________________________________________________________________________________________________________________________
Current Registry
Current Registration #
102010 SINGLE DOG REGISTRATION