SINGLE DOG REGISTRATION FORM DOMESTIC U.S. Resident American Bully Kennel Club Registration Dept. P.O. BOX 2677 Spotsylvania, VA 22553 Send a copy of the front and inside of your Pedigree Certificate (3 Generations) for verification of ownership and linage of the dog. Also include a front and side picture of your dog. Please see www.theabkcdogs.org for a listing of registries accepted by ABKC. Please mail all completed documents to the address listed. ABKC accepts Money Orders, Cashier Checks & Personal Checks made payable to American Bully Kennel Club. The ABKC now accepts PayPal. Please send a copy of your receipt in with the application. PayPal address is [email protected] Fees: $20.00 Per Dog- Domestic (if you live in the U.S) Processed Date:_______________________________ Bully ID #: ___________________________ ABKC #:_________________________________ Owner Information: Today’s Date: _______________ First Name: _________________________________________________________ MI: __________ Last Name: __________________________________________________________ Street Address: _________________________________________________ City: __________________________________ State: _______________ Zip: ______________________ Contact #: _______________________________ Alternate #: _______________________________ Email: _________________________________________________________ Has there been a change of address? YES NO Under penalty of perjury, all information provided on this form is true and correct to the best of my knowledge. x_________________________________________________________________ Owner Signature Co-Owner Information: Today’s Date: _______________ First Name: _________________________________________________________ MI: __________ Last Name: __________________________________________________________ Street Address: _________________________________________________ City: __________________________________ State: _______________ Zip: ______________________ Contact #: _______________________________ Alternate #: _______________________________ Email: ____________________________________________________________ Under penalty of perjury, all information provided on this form is true and correct to the best of my knowledge. x_________________________________________________________________ Co-Owner Signature Registering Dog Name as Shown on Pedigree (maximum characters 29) COLOR: **Breed Applying For Microchip # Current Registry Gender Date of Birth Current Registration # DNA # Breed Registered As SIRE Name as Shown on Pedigree (maximum characters 32) OFFICE USE ONLY ___________________________________________________________________________________________________________________________________________________________ Current Registry Current Registration # DAM Name as Shown on Pedigree (maximum characters 32) ______________________________________________________________________________________________________________________________________________________________________________ Current Registry Current Registration # 102010 SINGLE DOG REGISTRATION