North Australian Canine Association (Inc)
Trading as DOGS NT
A member Body of the Australian National Kennel Council
PO Box 37521, Winnellie NT 0821 Ph: 8984 3570 Fax: 8984 3409
Email:admin@dogsnt.com.au website: dogsnt.com.au
APPLICATION FOR REGISTRATION ON THE
ASSOCIATE REGISTER
Associate registration is available to any unregistered purebred or crossbreed dog which is to
be registered for competition in Non Conformation Exhibitions.
This application must be accompanied by a Sterilisation Certificate prior to the Associate Dog
being registered on the National ANKC Database.
I hereby apply for an Associate Registration with the NACA Inc and declare the dog is NEUTERED
in accordance with ANKC regulations.
Name of Dog:
(One word, maximum of 12 letters)
Date of Birth:
Sex: DOG
Colour:
Permanent Identification: Microchip
Number:
APPLICANT NAME:
M'SHIP No:
RESIDENTIAL ADDRESS
SUBURB
POSTCODE
POSTAL ADDRESS
SUBURB
POSTCODE
TELEPHONE (Home)
SIGNATURE
TELEPHONE (Bus/Mobile)
DATE:
Must contain signatures of all persons whose name is to appear as registered owners.
Version 3 November 2012 Current prices for this application are available on our web site or from the office.
FORM 09