Pre-registration Form 1 (04.23.04)

Official CTCA Pre-Registration Form Part 1 (version 4.23.04)

(Please print out a copy of this form; this is not a form that can be filled-out on-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 completed FORM 2 Forms (use a separate FORM 2 for 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, PLEASE EXPLAIN (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 for all the the CTCA does on behalf of breeders, individual Cotons, the breed and owners.

I hereby certify that the information I have provided on this form is correct. Further, to the best of my ability, I will report changes and corrections to the Secretary of the Coton de Tulear Club of America.

(13)

________________________________________________________________

(Breeder's Signature and date)

NOTE: ONLY THE BREEDER OF THIS LITTER CAN SUBMIT THIS APPLICATION

To return to The Coton News & Information Network'sregistration instructions, please click on:How To Register Your Litter (where you can download and print PART 2).