Dual-Sired Litter Registration Application

Both the Sire(s) and Dam must be registered with AMRA before submitting a litter registration application. A DNA profile certificate on each puppy must be submitted with this application for the litter to be considered for registration.

Email to: amra06@msn.com

Today's Date:

Date of Birth:

Did this litter result from the use of Artificial Insemination?

Yes

Number of living puppies:

Litter and payment information

Litter Processing Fee: $40 Per Puppy Fee: $5 ($5 fee pays for AMRA Certified Registration papers for that puppy, no cost to your customer) Example fees for litter of 2 puppies: Processing fee $40 + 1 male $5 +1 female $5 = $50 total cost.

OR

Litter Processing Fee: $45 (When your customer receives his/her paperwork, they will need to send it in with a $20 registration fee.) Note: If it has been more than 6 months since the litter was whelped a late fee of $30 will be added to the processing fee.

Total Amount Paid

Pay by PayPal to: amra06@msn.com

Optional Information
Please list the birth weight, bite, and/or color for each puppy below. For data purposes only. This information is not mandatory and will not have any effect on the registration process. It is intended for data collection only in order to develop an understanding along with statistical facts regarding Mi-Ki litters. (ie – average size, weight, color, etc.)

Mandatory Information
Please list the sex & coat type for each puppy as this determines a portion of the registration number. A DNA parentage certificate from BioPet Vet Lab must be submitted for each puppy to determine correct parentage. Puppy color.

Puppy Information (Add up to 8 puppies)

Puppy DN#:(Required)

Sex(Required)

Coat Type (long or smooth)(Required)

Color(Required)

Birth weight

Bite

Puppy End

Add another puppy

Was this litter the result of:

Natural Delivery

C-Section

Did all puppies survive during and/or after delivery?

Yes

If no, how many deceased puppies?

If no, please explain circumstances resulting in loss:

Dam Information

Dam’s Registered Name:

AMRA Registration Number:

Owner's Name:

Owner's Kennel Name:

Email:(Required)

Phone:

Address

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

Sire # 1 Information

Sire’s Registered Name:

AMRA Registration Number:

Owner's Kennel Name:

Owner's Name:

Email:

Phone:

Address

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

Sire # 2 Information

Sire’s Registered Name:

AMRA Registration Number:

Owner's Kennel Name:

Owner's Name:

Email:

Phone:

Address

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

Upload DNA Cetificates

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 256 MB.

AMRA Information

This application only constitutes consideration for registration and does not guarantee registration with AMRA. Each application for registration is considered on its merit. AMRA reserves the right to reject an application. The granting of registration is at the sole discretion of AMRA. I (we) understand that all applications become the property of AMRA. If an application has been falsified, no registration certificate will be issued and fees will not be refunded. If it is discovered, after registration, that any part of this application has been falsified, registration will be revoked for this dog and any progeny. The pedigree and all other information concerning any animal is provided by, and is solely the responsibility of, each respective owner. Each owner agrees to indemnify, hold harmless and defend this limited liability company and all its members and representatives from any claim or damages whatsoever based on any inaccurate or misleading information at any time provided by such owner. Venue of any dispute shall be exclusively in Pierce County, Washington, and the prevailing party shall be entitled to recover its reasonable attorney fees and all reasonable costs of litigation in addition to any relief awarded by the court. By signing, I certify that I am the owner of the above named Dam on the date of birth of the litter and that all of the representations on this application are true and I agree to comply with AMRA terms, rules, and regulations.

Signature of Dam Owner:

Date

Signature of Dam Co-Owner:

Date

I certify that the above named Dam was mated to the above named Sire(s) under the conditions indicated above and that the Sire(s) was owned/co-owned by me on the date of mating and that I agree to comply with AMRA terms, rules, and regulations.

Signature of Sire #1 Owner/Co-Owner:

Date

Signature of Sire #2 Owner/Co-Owner:

Date

AMRA Approved:

Date:

602-989-2083

amra06@msn.com