FROZEN SEMEN RELEASE
SEMEN OWNER’S AUTOHORIZATION TO REALEASE
FROZEN CANINE SEMEN FOR SHIPPING
(This from is to be used by the semen owner whenever he/she wishes to have frozen semen used for
artificial insemination. ICSB-ALB must have this release from on file.)
MAIL TO: INTERNATIONAL CANINE SEMEN BANK-ALBERTA, 6710-101 Avenue, Edmonton,
Alberta T6A 0H7  Telephone (780) 466-5655  FAX: (780) 466-5688
I hereby authorize INTERNATIONAL CANINE SEMEN BANK-ALB to release _____ vials of semen
from ___________________________, _______________________, _____________________
(Registered Name of Dog)
(Registry)
(Registration Number)
__________________________________________________
(Breed)
This semen is to be shipped to:
Phone No. (
_________________________________________
Name
) ______________
_________________________________________
Address
_________________________________________
Zip Code
The semen shipment should be shipped to arrive on/or before ___________ (Date). The shipping
charges should be billed to credit card number ________________________, Exp. _____/_____.
This credit card is in the name of ____________________________________.
The bitch owner is ___________________ Phone Number (
_______________
Date
Phone: (
) _______________
) _________________
______________________________________
Signature of owner of frozen semen
______________________________________
Printed Name
** Shipping Costs are usually paid for by the bitch owner, however, the semen owner is ultimately
responsible for all costs in the even the bitch owner fails to give payment. Tank Rental is
determined by location of destination. Canada $50.00, USA $80.00 and International $100.00.
Tanks not returned by 2 weeks will be liable for additional costs.