DPCA | Shows | Futurity | Bitch Nomination Form

DOBERMAN PINSCHER CLUB OF AMERICA INC.
Futurity Bitch Nomination Form

Futurity Year _____________

PLEASE PRINT PLAINLY
Name of bitch: _______________________________________________________ Date: ________________________________________
AKC reg#: __________________________________________________________ Bitch's date of birth:_____________________________
Owner or Lessee of Bitch: _______________________________________________ Phone: ( _____) ______________________________
Address: ____________________________________________________________ Email: _______________________________________
Date of breeding: _____________________________________________________ Estimated whelping date: _________________________
Name of sire: ________________________________________________________ Sire's date of birth: ______________________________
Owner of sire: _______________________________________________________ Phone: _______________________________________
Address: ____________________________________________________________ Email: _______________________________________
Check attached: $ ______________________________
IMPORTANT NOTE:
(CANCELLED CHECK WILL BE YOUR RECEIPT)
All breedings to be acceptable for Futurity nomination MUST conform to the Code of Ethics set forth by the Doberman Pinscher Club of America, Inc.
Make checks payable to DPCA
Owner or Lessee of Bitch:
_____________________________________________

SIGNATURE

By this signature, I consent to the DPCA providing my contact information to the Contracting Sponsors of the DPCA.

Fee of $15.00 for each Bitch Nomination must accompany Nomination Form.
Must be payable in US dollars only, and drawn on US banks only.
Litter nomination must be AFTER breeding, but BEFORE the litter is whelped.
Mail the above form with fee to Futurity Chairperson:
Diane Simmons
2631 Riding Ring Road
Norco, CA 92860-2531
E-Mail: DPCAFuturityDirector@dpca.org

Make out four forms:
held by Futurity Chairperson
held by Futurity Chairperson
will be sent to you marked "Accepted" when in order
will be held by you for your records
Ck# ________ Amt. ________
Postmarked _______________
Processed _________________
Accepted _____ Rejected _____

revised Nov 2011
revised May 2010

Name of bitch: _______________________________________________________	Date: ________________________________________
AKC reg#: __________________________________________________________	Bitch's date of birth:_____________________________
Owner or Lessee of Bitch: _______________________________________________	Phone: ( _____) ______________________________
Address: ____________________________________________________________	Email: _______________________________________
Date of breeding: _____________________________________________________	Estimated whelping date: _________________________
Name of sire: ________________________________________________________	Sire's date of birth: ______________________________
Owner of sire: _______________________________________________________	Phone: _______________________________________
Address: ____________________________________________________________	Email: _______________________________________
Check attached: $ ______________________________	IMPORTANT NOTE:
(CANCELLED CHECK WILL BE YOUR RECEIPT)	All breedings to be acceptable for Futurity nomination MUST conform to the Code of Ethics set forth by the Doberman Pinscher Club of America, Inc.
Make checks payable to DPCA
Owner or Lessee of Bitch:	_____________________________________________
	SIGNATURE
	By this signature, I consent to the DPCA providing my contact information to the Contracting Sponsors of the DPCA.
Fee of $15.00 for each Bitch Nomination must accompany Nomination Form. Must be payable in US dollars only, and drawn on US banks only. Litter nomination must be AFTER breeding, but BEFORE the litter is whelped. Mail the above form with fee to Futurity Chairperson: Diane Simmons 2631 Riding Ring Road Norco, CA 92860-2531 E-Mail: DPCAFuturityDirector@dpca.org

Make out four forms: held by Futurity Chairperson held by Futurity Chairperson will be sent to you marked "Accepted" when in order will be held by you for your records		Ck# ________ Amt. ________ Postmarked _______________ Processed _________________ Accepted _____ Rejected _____