AMERICAN BOLOGNESE CLUB - LITTER APPLICATION ONE TIME $15 FEE. EXPIRES 1 YEAR FROM BIRTHDATE. If both parents are not registered with the ABC, then please contact the registrar. If dam was leased or there was an ownership change, please use a transfer form and file with registrar. If this application is accepted the registrar will send the litter owner applications for each puppy in the litter for individual registration. This application form becomes the property of the club. Any misrepresentation on this application is cause for cancellation of registration(s) and may result in the loss of club privileges. PLEASE PRINT CLEARLY OR TYPE. Place of Birth of Litter______________________________________________ City, State, Zip Date of Birth __________________________ # living males ______ # living females _______ Registered Name and # of Sire ____________________________________________________ Registered Name and # of Dam ___________________________________________________ Owner of Sire Information I certify that the above Dam was mated to the said Sire. At the time of mating I was the owner of said sire. The mating took place in _____________________________________________(City, state or country) I witnessed the mating if live breeding or fresh AI. Circle one: yes or no If fresh chilled semen, or extender or frozen semen, name, address & email of person/vet collecting ____________________________________________________________________________ Signature of person collecting ____________________________________________________ Print name of Owner of Sire _____________________________________________________ Signature of owner of Sire ___________________________________ Date _______________ Address and email _____________________________________________________________ Owner of Dam Information I hereby apply to register this litter. I certify that I was the owner of the above named dam on the date of birth of the litter. I certify that the said dam was not bred to any other dog at this time. All representations on this application are true. I have read and agree to abide by the rules and ethics for the American Bolognese Club. I witnessed mating if live breeding or fresh AI. Circle one: yes or no If fresh chilled semen, or extender or frozen semen, name, address & email of person/vet inseminating ____________________________________________________________________________ Signature of person inseminating _________________________________________________ Print name of Owner of Dam_____________________________________________________ Signature of Owner of Dam __________________________________ Date _______________ Address and email _____________________________________________________________ Mail check or money order for $15 to Interim Registrar Marsha England, 24954 T Road, Cedaredge, CO 81413 rec ________ by ______ form rev. 6/14