USABC Scorebook Application

Please fill out this form in its entirety. Fees: $11.50 for a single scorebook.

Only one dog per application please.
Name of Owner*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone*
USABC Member Number*
Club Affiliation Name and Number
Full Name of Dog*
Dog's Date of Birth*

MonthDayYear
Date
Sex of Dog*

MaleFemale
Call Name*
Registry*
Registration Number*
Previous Titles Earned W/Organization
ID Tattoo or Microchip*

Tattoo:Microchip:
ID Number*
Hip Certification

OFAPennHIP
Hip Certification Number:
PLEASE ATTACH COPIES OF THE FOLLOWING DOCUMENTATION:
Minimum 3 Generation Pedigree Registration Papers, Mandatory.*

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TWO PHOTOGRAPHS OF APPLICANT DOG, MANDATORY. MUST BE IN COLOR (1) FRONT AND (1) SIDE VIEW.*

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HIP CERTIFICATIONS OR OTHER HEALTH CERTIFICATES IF APPLICABLE.

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PREVIOUS SCOREBOOK OR CERTIFICATIONS OF TITLES EARNED, UNLESS REQUESTING A BLANK SCOREBOOK.

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Applicant Signature*

Clear
Date*

MonthDayYear
Date
For more information visit: WWW.USAMERICANBULLDOG.COM
Should be Empty: