BCSA Futurity Litter Nomination Form

Dam's Registered Name*

Dam's AKC Number*

Sire's Registered Name*

Sire's AKC Number*

Whelping Date*

Total Number of Pups in Litter*

Number of Males*

Number of Females*

Breeder(s) of Record*

List the first BCSA member of record as contact, followed by the other Breeders.

Breeder's Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Breeder's Email*

Breeder's Phone*

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).

Litter Nomination Fee*

$10/puppy
$15/puppy after 3 months of age

Quantity*

How many puppies are you nominating?

Total

$0.00