C/O 7505 North 11th Ave.
Omaha Nebraska 68142
(807) 632-2949 
E-Mail: globetrotter_5764@yahoo.ca
Staple
Animal's
Picture
Here
LLBA APPLICATION FOR "CERTIFICATE OF REGISTRATION"
Note* All information on this application is subject to verification, and any manufactured information
given herein will automatically void the registrability of this animal. All LLBA/ARBA/BBC Certified
Pedigrees are subject to correction or cancellation. Reg. Fee is nonrefundable.
Please state level of registration
________________________________________________________________________
Reg. Fee: $15.00 (includes LLBA 5 generation pedigree)
Postal Money Order or Cash Please or PayPal (send PayPal money to globetrotter_5764@yahoo.ca
c/o LLBA)
Make money orders payable to the Lana Lines Bulldog Association c/o Koral Hamilton or Adrianne
Harrison Jameson
No Personal Checks or Credit Cards
NAME OF REGISTERED ANIMAL:
_____________________________________________________________________________________________________
(Animal's name not to exceed 30 Letter Spaces)
COLOR: _________________________________________________________________________________SEX: ________________
D.O.B._________________TOTAL NO. BORN________________LIVING MALES______________LIVING FEMALES_____________
BREED OF ANIMAL: _______________________________________________________________________________________
NAME OF SIRE: ________________________________________________________________________REG. NO.______________
Name of Sire's Breeder:
________________________________________________________________________________________________
NAME OF DAM: ________________________________________________________________________REG. NO.______________
Name of Dam's Breeder:
________________________________________________________________________________________________
NAME OF BREEDER SELLING THE LITTER:
_____________________________________________________________PH.:_______________________________
NAME OF NEW
OWNER:____________________________________________________________________________________________
PHONE NUMBER(S): ____________________________________________________________________________________________
OWNER’S ADDRESS: ___________________________________________________________________________________________
_______________________________________________________________________________________________________________
OWNER’S EMAIL: _____________________________________________________________________________________________
©Lana Line Bulldog Association
APPLICATION INSTRUCTIONS
Check one or more items below that meet your circumstance:
List or attach that information to this application.
_______Attach copies of Sire's and/or Dam's LLBA Certificate of Registration.
_______Supply LLBA Litter Registration Number (You may need to contact your
animal's breeder for this information.):
_____________________________thru________________________________
Note: If your Sire and/or Dam were not originally registered with LLBA, you must:
_______Provide the LLBA with a copy of your Sire's and/or Dam's Certificate of
Registration (including Pedigree)
Or complete the Extended Pedigree on page 3 of this application (A 5-Generation
Pedigree is required, including the above-named animal.)
I, the applicant, certify that the information given on this application is true and correct to
the best of my knowledge.
_____________________________________________________
Applicant's Signature
OPTIONAL INFORMATION
Microchip No.: ________________________________________
DNA Cert. No.:__________________________________
Tattoo No.: ___________________________________________
Spayed: Yes__________ No__________
Penn Hip: R.____________________L.____________________
Neutered: Yes _________ No __________
OFA Rating: __________________________________________
Planning to Breed: Yes ________ No ________
©Lana Line Bulldog Association
Extended Pedigree for LLBA Certificate of Registration Application – please provide complete information and submit with your application
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©Lana Line Bulldog Association
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