Litter Nomination Form

**Litter must be nominated before it is born**

Fee: $20

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*=required

Dam Owner Information
Litter Nominated By (must be a CSPCA member and owner (or Lessee) of Dam*
Address*
City*
State*
Zip Code*
Phone*
Email*
Co-Owner Information
Co-Owner(s) of Dam (or Lessee)
Address
City
State
Zip Code
Phone
Email
Dam and Sire of Nominated Litter (one must be major-pointed and both must be over one year old)
Dam Name*
Dam AKC Reg#*
Dam Date of Birth*
Date, name of Kennel Club and location of show at which major points were earned (if Dam has more than one major, you need only list the last major win.) NOT NECESSARY IF A CHAMPION OF RECORD.
Sire Name*
Sire AKC Reg#*
Sire Date of Birth*
Date, name of Kennel Club and location of show at which major points were earned (if Sire has more than one major, you need only list the last major win.) NOT NECESSARY IF A CHAMPION OF RECORD.
Sire Owner Information
Owner of Sire*
Address*
City*
State*
Zip Code*
Phone*
Email*
Sire Co-Owner Information
Co-Owner(s) of Sire (or Lessee)
Address
City
State
Zip Code
Phone
Email
Breeding Information
Dates of Breeding*
Estimated Whelp Date*
"Futurity/Maturity Judge Nomination" Nominee must be an AKC approved judge in good standing with the AKC and eligible to judge the Chinese Shar-Pei and approved to judge at the Group level (but not necessarily the Non-Sporting group) at an AKC licensed show. The Nominee may not have judged at any other CSPCA National Specialty event for at least five years and cannot be judging any other National Specialty class that year.
Name of AKC Judge you nominate for Futurity/Maturity judging at Nationals
First Name*
Last Name*
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 litter nomination is true and correct to the best of my (our) knowledge. This litter nomination is being submitted on the foregoing representation and agreement.
Signature*
Date*
11/17/2017
How will you be paying the registration fee?*

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