Official CTCA Pre-Registration FormPart 1 (version 4.23.04)

(Please print out acopy of this form; this is not a form that can be filled-outon-line)

DATE SUBMITTED: ___________________________

BREEDER: ________________________________________________________

BREEDER's PHONE and EMAIL:

________________________________________________________________

INSTRUCTIONS: Use only one Form 1 for each LITTER.Complete all blanks, then enclose this form with completedFORM 2 Forms (use a separate FORM 2for each puppy in the litter) and a check made payable to the "CTCA."

MAIL ALL MATERIALS TO:

Dr. Robert Jay Russell
Coton de Tulear Club of America
PO Box 600
Windsor, NY 13865 USA

PLEASE PRINT OR TYPE

(1) LITTER BIRTH DATE: _______________

(2) PUPPIES (Names) and (3) GENDER and (4) PUPPY QUALITY(Potentially Breedable, "PB," or Not Breedable, "NB"):

(Example: Perdita Valiha of Alika Cotons, Female PB )

1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

4. _______________________________________________________

5. _______________________________________________________

6. _______________________________________________________

7. _______________________________________________________

8. _______________________________________________________

 

(5) WERE THERE ANY PUPPY DEATHS WITHIN THIS LITTER? IF SO, PLEASEEXPLAIN (this information helps us help breeders):

______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

(6) SIRE: ______________________________________________________

(7) SIRE'S OWNER: ____________________________________________

(8) SIRE'S CTCA REGISTRATION NUMBER: ___________________

(9) DAM: _______________________________________________________

(10) DAM'S OWNER: ____________________________________________

(11) DAM'S CTCA REGISTRATION NUMBER: ___________________

(12) CALCULATIONS OF FEES:

NUMBER of NOT BREEDABLE PUPS: ________ @ $200 each =__________

NUMBER of POTENTIALLY BREEDABLE: _____ @ $250 each = __________

TOTAL FEES SUBMITTED WITH THIS LITTER = __________

I understand the the fees shown reflect a sum of contributions forall the the CTCA does on behalf of breeders, individual Cotons, thebreed and owners.

I hereby certify that the information I have provided on this formis correct. Further, to the best of my ability, I will report changesand corrections to the Secretary of the Coton de Tulear Club ofAmerica.

(13)

________________________________________________________________

(Breeder's Signature and date)

NOTE: ONLY THE BREEDER OF THISLITTER CAN SUBMIT THIS APPLICATION


To return to The Coton News &Information Network's registration instructions, pleaseclick on: How To Register YourLitter (where you can download and print PART 2).


Title and contents of The Coton de Tulear News & InformationNetwork © 1996-2004, the Coton deTulear Club of America, all rights reserved. Celebrating the CTCA's30th Anniversary in 2006.