Leavitt Bulldog Association© 2005
Application for registration
Dog’s
name___________________________________________
Breeder’s name________________________________________
Breeder’s
Phone #_____________________________________
Breeder’s E-mail address________________________________
New
owner’s name_____________________________________
New owner’s phone #___________________________________
New
Owner’s Home address______________________________
New
Owner’s E-mail address______________________________
Sex
of dog__________ Color of dog________________________
DOB______________
Tail
is (check one)
Pump__ Straight___ Crooked____ Cork
Screw___ Bobbed_____
Wry jaw______ (yes/no)
Signature
of person submitting application for registration_____________________
By
your signature you are stating this application is true and correct to the best
of your knowledge
** Include the registration #’s for all dogs in
the pedigree that have been LBA registered.**
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Mail To: Leavitt Bulldog
Association Registrations
Mary Courville