Arkansas Thoroughbred Breeders’ and Horsemen’s Association
P.O. Box 21641  Hot Springs, Arkansas 71903-1641
Telephone (501) 624-6328  FAX (501) 623-5722
Email atbha@att.net
APPLICATION FOR REGISTRATION OF BROOD MARE
Date ___________________, 200_____
Name of Mare ___________________________________ Color ______________ Date of Birth ____________________
Sire ________________________________________ Dam ________________________________________________
Jockey Club
Date
From
Registration No._________________________ Acquired _________________ Whom __________________________
Present Location of Brood Mare _______________________________________________________________________
(Farm)
Name of Owner/Owners ______________________________________________________________________________
(all interest must be given)
(if stallion is leased, attach a copy of the Lease Agreement)
Address of Owner/Owners ____________________________________________________________________________
(complete address of all owners must be given)
______________________________________________
Signature of Owner or Agent
______________________________________________
Street, Route No. and/or Box No.
______________________________________________
Social Security No. of Owner
______________________________________________
City and State
Zip Code
______________________________________________
Telephone Number of Owner
_____________________ ________________________
FAX Number
E-mail Address
ENCLOSE COPY OF JOCKEY CLUB CERTIFICATE, BOTH FRONT AND BACK (SHOWING OWNERSHIP TRANSFERS)
ENCLOSE COPY OF JOCKEY CLUB CERTIFICATE, BOTH FRONT AND BACK (SHOWING OWNERSHIP
FOR OFFICE USE ONLY
TRANSFERS)
Ark. Registration
No. _______________________________
ENCLOSE COPY
OF JOCKEY CLUB CERTIFICATE, BOTH FRONT AND BACK (SHOWING OWNERSHIP
TRANSFERS)
Issued ___________________________________, 20____
By ______________________________________________
ENCLOSE COPY OF JOCKEY CLUB CERTIFICATE, BOTH FRONT AND BACK (SHOWING OWNERSHIP
TRANSFERS)
Return completed application, copy of Jockey
Club Certificate and applicable registration fee to: 
A.T.B.H.A.
CLOSE COPY OF JOCKEY CLUB CERTIFICATE,
BOTH FRONT AND BACK (SHOWING OWNERSHIP
P.O. Box 21641
TRANSFERS)
Hot Springs,
AR 71903-1641
Member Fee - $ 50.00
www.atbha.com
Phone (501) 624-6328
Non Member Fee - $100.00
FAX
(501) 623-5722
Late Member Fee - $500.00
Email atbha@direclynx.net