IWC Litter Registration Application

Date *

Must use mm-dd-yyyy format, or use calendar icon to choose Date Picker Icon

Breeder(s) *

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Country

Best Phone Number *

Area Code Phone Number

Email *

example@example.com

Sire's Registered Name

Sire's Registration Number

Sire's DN Number

Dam's Registered Name

Dam's Registration Number

Dam's DN Number

Litter Birthdate *

Date Date Picker Icon

Number Puppies in Litter *

Please send copies of MDR1 & CEA Lab Reports on all puppies.
If BOTH parents are N/N (+/+ or A) for MDR1 and/or CEA, send the PARENTS lab reports unless already on file with Registrar.
If one or both parents are smooth coated Windsprites, send copies of the FGF5 coat length test results.

Send all lab reports and any questions to Treasurer4IWC@gmail.com

Fees:

Litter Registration & Registration Certificates: $20 + $5 per puppy

Certified Pedigress: add $5 per puppy

International (outside of USA) please add $5 for postage

PAYMENT

PayPal Checkout or PayPal Credit (below) Mail check or money order payable to IWC. Send to IWC c/o 33 Pine Grove Rd, Nottingham PA 19362

PAYPAL CHECKOUT OR PAYPAL CREDIT

Litter Regstration $ 20.00

Number of Puppies $ 5.00

Quantity

Certified Pedigrees (optional) $ 5.00

Quantity

International Postage $ 5.00

Total $ 0.00

loading smart payment buttons...

When form is complete, scroll to very end of form and click on the red SUBMIT button.

Puppy Information

When you have completed information on all puppies, scroll to the very end of the form for button to submit application.

(Payment will not actually process until you submit the form.)

(There is space on the form for 10 puppies. If you have more than 10, please contact registrar at Treasurer4IWC@gmail.com.)

Puppy # 1

Time

: Hour Minutes AM/PM Option

#1 Registered Name

#1 Call Name

#1 Variety

Longhair Smooth

#1 Gender *

Male Female

#1 DN Number

#1 Microchip Number

(if any)

#1 Color *

#1 Markings

#1 MDR1 *

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#1 CEA *

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#1 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#1 Owner(s)

#1 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#1 Owner Phone Number

Area Code Phone Number

#1 Owner Email

example@example.com

Puppy # 2

#2 Registered Name

#2 Call Name

#2 Variety

Longhair Smooth

#2 Gender

Male Female

#2 DN Number

#2 Microchip Number

(if any)

#2 Color

#2 Markings

#2 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#2 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#2 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#2 Owner(s)

#2 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#2 Owner Phone Number

Area Code Phone Number

#2 Owner Email

example@example.com

Puppy # 3

#3 Registered Name

#3 Call Name

#3 Variety

Longhair Smooth

#3 Gender

Male Female

#3 DN Number

#3 Microchip Number

(if any)

#3 Color

#3 Markings

#3 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#3 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#3 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#3 Owner(s)

#3 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#3 Owner Phone Number

Area Code Phone Number

#3 Owner Email

example@example.com

Puppy # 4

#4 Registered Name

#4 Call Name

#4 Variety

Longhair Smooth

#4 Gender

Male Female

#4 DN Number

#4 Microchip Number

(if any)

#4 Color

#4 Markings

#4 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#4 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#4 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#4 Owner(s)

#4 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#4 Owner Phone Number

Area Code Phone Number

#4 Owner Email

example@example.com

Puppy # 5

#5 Registered Name

#5 Call Name

#5 Variety

Longhair Smooth

#5 Gender

Male Female

#5 DN Number

#5 Microchip Number

(if any)

#5 Color

#5 Markings

#5 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#5 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#5 FGF5 Coat Length(must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#5 Owner(s)

#5 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#5 Owner Phone Number

Area Code Phone Number

#5 Owner Email

example@example.com

Puppy # 6

#6 Registered Name

#6 Call Name

#6 Variety

Longhair Smooth

#6 Gender

Male Female

#6 DN Number

#6 Microchip Number

(if any)

#6 Color

#6 Markings

#6 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#6 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#6 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#6 Owner(s)

#6 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#6 Owner Phone Number

Area Code Phone Number

#6 Owner Email

example@example.com

Puppy # 7

#7 Registered Name

#7 Call Name

#7 Variety

Longhair Smooth

#7 Gender

Male Female

#7 Number

#7 Microchip Number

(if any)

#7 Color

#7 Markings

#7 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#7 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#7 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#7 Owner(s)

#7 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#7 Owner Phone Number

Area Code Phone Number

#7 Owner Email

example@example.com

Puppy # 8

#8 Registered Name

#8 Call Name

#8 Variety

Longhair Smooth

#8 Gender

Male Female

#8 DN Number

#8 Microchip Number

(if any)

#8 Color

#8 Markings

#8 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#8 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#8 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#8 Owner(s)

#8 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#8 Owner Phone Number

Area Code Phone Number

#8 Owner Email

example@example.com

Puppy # 9

#9 Registered Name

#9 Call Name

#9 Variety

Longhair Smooth

#9 Gender

Male Female

#9 DN Number

#9 Microchip Number

(if any)

#9 Color

#9 Markings

#9 MDR1

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#9 CEA

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#9 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#9 Owner(s)

#9 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#9 Owner Phone Number

Area Code Phone Number

#9 Owner Email

example@example.com

Puppy # 10

#10 Registered Name

#10 Call Name

#10 Variety

Longhair Smooth

#10 Gender

Male Female

#10 Number

#10 Microchip Number

(if any)

#10 Color

#10 Markings

#10

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#10

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C)

#10 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A) N/M (+/-) (B) M/M (-/-) (C) N/A

#10 Owner(s)

#10 Owner Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

#10 Owner Phone Number

Area Code Phone Number

#10 Owner Email

example@example.com

Please enter any comments or additional information