BCSA: Futurity Nomination

DAM/SIRE INFORMATION

Dam Name:

Dam AKC #:

Dam Birth Date:

Sire Name:

Sire AKC #:

Sire Birth Date:

Whelping Information:

Date Whelped:
No. Male Pups:
No. Female Pups:

OWNER/CO-OWNER INFORMATION

Owner Name:

Co-Owner Name:

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:

OWNERS

Please 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?

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)