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.*

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Declaration Date*

MonthDayYear
Registration payment details

Please pay corresponding fees to QWSDAI; Registered parents $5, Unregistered parent(s) $10. 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