Queensland Working Sheep Dog Association - Form of Application for Registration

Queensland Working Sheep Dog Association - Form of Application for Registration

For the registration of unregistered dogs (dogs with Q number or corresponding state working sheep dog registration are to be transferred using Registration of Transfer form)
Owner Name
Owner Address
(Please include full address)
Name of Dog
Sex
Date of Birth
Breed
Colour
PEDIGREE
Sire   Type a label   Rego #   Type a label

Sire's Sire   Type a label   Rego #   Type a label

Sire's Dam   Type a label   Rego #   Type a label

Dam   Type a label   Rego #   Type a label

Dam's Sire    Type a label   Reg # Type a label

Dam's Dam   Type a label   Reg # Type a label
Breeder Name
Breeder Address
I solemnly declare that the above to be correct in every particular.
Declaration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Registration payment details

Please pay corresponding fees to QWSDAI; Registered parents $10, Unregistered parent(s) $20. Account name: Queensland Working Sheepdog Association Inc.; BSB: 484-799; Account Number: 204 296 370; Reference: (Your Name) dog registration
Should be Empty:

Registration payment details