Futurity Puppy Nomination Form

**Puppy must be nominated before the age of 4 months**

Futurity Only - $15.00
Futurity & Maturity - $25
Certificate - $10.00 extra fee
Both Nominations Plus A Certificate - $35

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*=required

Owner Information
Name of Owner* and nominator of puppy*
Email*
Address*
City*
State*
Zip Code*
Phone*
If Owner Is Not Breeder:
If owner is not breeder, date purchased Futurity puppy:
Name of CSPCA member breeder
Address
City
State
Zip Code
Phone
Co-Owner Information (if applicable)
Co-Owner(s) if any
Address
City
State
Zip Code
Phone
Dog Information

For a Futurity puppy to be eligible to compete at the Futurity, the Owner of Record, at the time of judging the Futurity, must be a member in good standing with the CSPCA. The Futurity Director must be notified of any change in ownership of a Futurity puppy, in writing, to maintain its eligibility to compete at the Futurity

Full Registered Name of Futurity Puppy* (Name must be entered if registration number is not available)
PLEASE CHECK CAREFULLY AS THIS IS USED FOR CERTIFICATES
AKC Litter Registration#*
AKC Registration#*

If AKC registration # is not available, a name MUST be provided or the nomination will be returned. Both name and registration number must be received by the Futurity Director immediately upon receipt but no later than 15 days prior to the first day of the National Specialty Futurity judging. (AKC Reg# must be received for a certificate to be issued)

Date Of Birth*
Dog or Bitch*
Coat Type*
Name of Dam*
AKC Reg#*
Name of Sire*
AKC Reg#*
I (we) acknowledge that the �National Specialty Futurity Event� Rules and Regulations have been made available to me (us) and that I (we) are familiar with its contents and agree to be bound by these Rules and Regulations, as may be amended from time to time. I (we) certify and represent that the information contained in this puppy nomination is true and correct to the best of my (our) knowledge. This puppy nomination is being submitted on the foregoing representation and agreement.
Signature*
Date*
3/29/2017
Payment Selection (payment options & information on following page)*
Futurity Only - $15.00    Futurity & Maturity - $25.00    Certificate - Additional $10.00 Fee    Both Nominations Plus A Certificate - $35.00
How will you be paying the registration fee?*

Please type the numbers for verification


 

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