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Breeding for a

pals.JPG (3490 bytes)

healthy future


 
 

Applications may be copied to your printer or obtained from:

Address: GDC, PO Box 222, Davis, California 95617
Phone/Voice Mail/Fax:-530-756-6773

Updated April 2, 1999

 
 
OPHTHALMOLOGIST'S NAME
 
BREED SEX
 
DOG'S REGISTERED NAME
 
CALL NAME NUMBER IN LITTER
 
K.C. Registration No. Birth Date
 
Owner's Name
 
Owners Address
 
City State Zip Phone
 
Name of Breeder
 
Breeders Address
 
City State Zip Phone
 
Sire's Registered Name K.C. Regis. 
 
Dam's Registered Name  K.C.Regis.


Fee included (payable to GDC) $ ______

No charge for Affected Entries

 

 

I hereby certify that the data submitted is of the dog described on this application. I am aware that the data will be public information and will be maintained for the purpose of improving the breed and lowering the risk of genetic diseases, as well as for research purposes.

Owner's signature:_______________________ Date:___/___/____

Institute for Genetic Disease Control in Animals /2295761@mcimail.com/ Revised April 4, 1999