BCSA: Futurity Nomination

DAM/SIRE INFORMATION

Dam Name:

Dam AKC #:

Dam Birth Date:

Sire Name:

Sire AKC #:

Sire Birth Date:

Breeding Date

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:

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)