NNRBA
                                                               SHORT FORM                           Instructions
.National New And Rare Breed Association
CERTIFICATE/PEDIGREE APPLICATION
PRINT - FILL OUT AND  SEND TO:
NNRBA
41 Bodwell Road
East Hartford, CT 06108-1520
Phone 860-282-0363
Questions?  E-mail nnrba@snet.net
Registration fees are listed below on the Fee Schedule
Online Registration Form
SECTION A. Description of Dog

Breed of Dog___________________Sex_______Eye color_______________Nose color_____________

Coat color__________________________Date of Birth_______________________Weight_________ 

Patterns/Markings____________________________________________________________________

Breeders Kennel Name________________________Reg. #(if previously registered)_________________

Name of Dog being recorded. Submit 2 different choices.  Leave a space between words. If dog is already registered with another association, the name must remain the same.

1st choice ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __ 

2nd choice ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __ 

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SECTION B Information on Owner(s) 

Name of Owner____________________________________Address_____________________________

City_____________________________________________State______________Zip_______________

Phone#________________________________Signature_______________________________________

Name of Co-Owner_________________________________Address_____________________________

City_____________________________________________State______________Zip______________

Phone#________________________________Signature______________________________________

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SECTION C REQUIRED Information on Breeder or Person dog was obtained from

Name of Breeder _____________________________________  Phone__________________________

Address_____________________________City_________________State________Zip____________
SECTION D  Fill in Sire and Dam  information.
Description of Sire

Breed of Dog______________________________Eye color_______________Nose color____________

Coat color__________________________Date of Birth_______________________Weight________

Patterns/Markings____________________________________________________________________

Sire's Name________________________________Reg. #(if previously registered)__________________
 
Description of Dam

Breed of Dog______________________________Eye color_______________Nose color____________

Coat color__________________________Date of Birth_______________________Weight________ 

Patterns/Markings____________________________________________________________________

Dam's Name_______________________________Reg. #(if previously registered)__________________
 

Enter the letter for the type of pedigree/certificate requested from the Fee Schedule___.

Please include check or money order. Amount enclosed____________.

FEE SCHEDULE

A. REGISTRATION CERTIFICATE: non-photo $10.00

                             B. PHOTO ID CERTIFICATE: $12.00 for single dog registration
                             C. PHOTO ID CERTIFICATE: $15.00 listing parents and grand parents
                             D. 3 GENERATION CERTIFICATE: non-photo $20.00
                             E. 4 GENERATION CERTIFICATE: non-photo $25.00

LITTER REGISTRATION FEE:
$2.00 per litter to cover postage and materials if mailed in. FREE Online litter registration
Proper registration fee must be received in the mail before the application can be processed.
Copyright © 2000 National New and Rare Breed Association  (NNRBA)