DPCA | Shows | Futurity | Puppy Nomination Form

DOBERMAN PINSCHER CLUB OF AMERICA INC.
Futurity Puppy Nomination Form

Futurity Year _____________

PLEASE PRINT PLAINLY

AKC Registered Name: ________________________________________________________		AKC reg #:	_________________________________
Registration number must be supplied as soon as available and in no case later than three (3) weeks before the stake judging
Whelping date:_____________________________________ Sex: ______________________		Color:	_________________________________
Dam: _______________________________________________________________________		AKC reg#:	_________________________________
Sire: _______________________________________________________________________		Owner of sire:	_________________________________
Name of Breeder(s): ___________________________________________________________		Phone:	(____) ___________________
Name of Person(s) [Owner(s)] under whom puppy will be entered in catalogue: _____________________________________________________________
_________________________________________________________________________________________________________________________
Address:_____________________________________________________________________		Phone:	(____) ___________________
Signature of owner/agent:	______________________________________________________	Date:	_________________________________
By this signature, I consent to the DPCA providing my contact information to the Contracting Sponsors of the DPCA.
Address:__________________________________________________________________________________________________________________
Email:_______________________________________________________________________		Phone:	(____) ___________________
Check attached:	$____________________________
(CANCELLED CHECK WILL BE YOUR RECEIPT)
Make checks payable to DPCA
Fee of $15.00 for DPCA members, $25.00 for non-members will complete eligibility of each puppy's nomination for the futurity. Must be payable in US dollars only, and drawn on US banks only. 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 maked "Accepted" when in order will be held by you for your records			Ck# ________ Amt. ________ Postmarked _______________ Processed _________________ Accepted _____ Rejected _____

revised May 2010