BCSA: Futurity Nomination

DAM/SIRE INFORMATION

Dam Name:

Dam AKC #:

Dam Birth Date:

Sire Name:

Sire AKC #:

Sire Birth Date:

SIRE'S OWNER/CO-OWNER INFORMATION

Sire's Owner Name:

Sire's Co-Owner Name:

WHELPING INFORMATION

Whelping Date:

Puppy Information:

Total Pups:
No. Male:
No. Female:

BREEDER(S) OF RECORD: List the first BCSA member of record as contact, followed by the other breeders.

Names:

Street Address:

City/State/Zip:

Contact Info:

Telephone
E-Mail
Re-enter E-mail:

CURRENT OWNERS: List the current owner AND owner's address of each puppy produced from this breeding, which is able to compete (puppies that have been spayed or neutered are not eligible).

Owner 1:

Owner 2:

Owner 3:

Owner 4:

Owner 5:

Owner 6:

Owner 7:

Owner 8:

Owner 9:

Owner 10:

Owner 11:

Owner 12:

Owner 13:

JUDGE: Whom would you like to Judge at the Futurity? (ONE name only per venue.)

Herding Judge:

Conformation Judge:

MEMBER AGREEMENT

I hereby nominate the above litter for the BCSA Futurity and confirm that I am a member in good standing with the BCSA.
By selecting "Yes" below and entering my name, it has the same effect of my personal signature.

Agree:

(R)

Member Name:

(R)