North American Tsvetnaya Bolonka
Dog Registration Application

Breed:________________________				
Registration Number:______________________

Date of Birth:__________________				

Sire:____________________________			Dam_________________________

Breeder:_______________________________________________

Litter owner:___________________________________________

Fees: NATBC Registration $15.00    Cash, check, or money order 
Send form and fee to :  NATBC REGISTRATION, 70 RT. 130, PEDRICKTOWN, NJ 08067

Name of Dog:_______________________________________________

Sex of Dog:________________________________________________

Limited:    ___________YES ________________NO

Color:____________________________________________________

Litter Owner Information:
_________I (we) still own this dog and apply for registration and to have the ownership recorded in my (our) name(s).

_________I (we) transferred this dog directly to the first owner (s) listed in the Transfer Record Section below

I (we) certify by my (our) signatures(s) that all the information appearing on this application is correct and that I (we) agree that any cause of action, controversy or claim arising out of or related to this registration or as to the construction, interpretation and effect of this agreement shall be settled by arbitration pursuant to the applicable rules of the American Arbitration Association. However, prior to arbitration all applicable NATBC bylaws, rules, regulations, and procedures must first be followed as set forth in the NATBC charter and bylaws, rules, regulations, published policies and guidelines.

___________________________   _________________________   _______________________

Transfer Record: When a dog changes hands more than once before it is individually registered, the name (s) of each person and organization through whose hands the dog passes and the date the dog was received must be entered as directed on the lines provided below. 

________________________________ ____________________________ _______________
Printed Name				     Signature					Date	
Registering Owners:

Date Dog Received: _________Month________Day____________Year

______________________________________		______________________________
Registering Owner’s First Name				Registering Owner’s Last Name

_____________________________________________________________________________
Mailing Address

_______________________________	_______	_____________________________
City						State		Zipcode

______________________________________	____________________________________
Registering Co-Owner’s First Name			Registering Co-Owner’s Last Name

I (We) apply to the North American Tsvetnaya Club to have a registration certificate for this dog issued in my (our) names(s) and certify that I (we) acquired this dog on the date stated. I (we) agree to abide by all rules and regulations of the North American Tsvetnaya Club. I (WE) understand that if the limited box on the dog registration application has been checked by the litter owner(s), I (we) will receive a limited registration certificate. I (we) agree that any cause of action, controversy or claim arising out of or related to this registration or as to the construction, interpretation and effect of this agreement shall be settled by Arbitration pursuant to the applicable rules of the American Arbitration Association. However, Prior to arbitration all applicable NATBC bylaws, rules, regulations, and procedures must first be followed as set forth in the NATBC charter and bylaws, rules, regulations, published policies and guidelines.

______________________________________	___________________________________
Registering Owner’s Signature			Registering Co-Owner’s Signature

Revised May 2004