form

NNRBA

LONG 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______________________________________

********************************************************************************************************************

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

Name of Breeder ______________________________________ Phone__________________________

Address_____________________________City_________________State________Zip____________

SECTION D Pedigree information.
Please fill in as much of this section as possible.

	Name of Grandsire .	Name of Great Grandsire
	Coat Color .	Coat Color
	Nose Color .
Name of Sire	Date of Birth	Name of Great Grandam .
Coat Color	Reg#	Coat Color .
Nose Color .	.
Date of Birth	Name of Grandam .	Name of Great Grandsire
Reg#	Coat Color .	Coat Color
	Nose Color .
.	Date of Birth .	Name of Great Grandam
	Reg#	Coat Color .
	.
	Name of Grandsire .	Name of Great Grandsire
	Coat Color	Coat Color .
	.	Nose Color .
Name of Dam .	Date of Birth	Name of Great Grandam
Coat Color .	Reg#	Coat Color
Nose Color .	.
Date of Birth	Name of Grandam .	Name of Great Grandsire
Reg#	Coat Color	Coat Color .
	Nose Color .
	Date of Birth	Name of Great Grandam .
	Reg#	Coat Color .

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.