IWC Litter Registration Application

IWC Litter Registration Application
Date

Month Day Year
Must use mm-dd-yyyy format, or use calendar icon to choose
Breeder(s) *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country
Best Phone Number *

Area Code Phone Number
Email *
example@example.com
Sire's Registered Name
Sire's Registration Number
Sire's DN Number
(If known)
Dam's Registered Name
Dam's Registration Number
Dam's DN Number
(If known)
Litter Birthdate *

Month Day Year
Date
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
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Litter Regstration $ 20.00

Number of Puppies $ 5.00

Quantity
Item subtotal: $ 0.00

Certified Pedigrees (optional) $ 5.00

Quantity
Item subtotal: $ 0.00

International Postage $ 5.00

Total $ 0.00
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The payment is ready! It will be completed once you submit the form.
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
#1 Registered Name
#1 Call Name
#1 Puppy Name or ID
(The name that could be on DNA parentage, MDR1, FGF5, or CEA results.)
#1 Variety

Longhair Smooth
#1 Gender *

Male Female
#1 Color *
#1 Markings
#1 DN Number
#1 Microchip Number
(if any)
#1 MDR1 *

N/N (+/+) (A) (Normal) N/M (+/-) (B) (Carrier) M/M (-/-) (C) (Affected)
#1 CEA *

N/N (+/+) (A) (Normal) N/M (+/-) (B) (Carrier) M/M (-/-) (C) (Affected)
#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
#1 Owner Phone Number

Area Code Phone Number
#1 Owner Email
example@example.com
Puppy # 2
#2 Registered Name
#2 Call Name
#2 Puppy Name or ID
#2 Variety

Longhair Smooth
#2 Gender

Male Female
#2 Color
#2 Markings
#2 DN Number
#2 Microchip Number
(if any)
#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
#2 Owner Phone Number

Area Code Phone Number
#2 Owner Email
example@example.com
Puppy # 3
#3 Registered Name
#3 Call Name
#3 Puppy Name or ID
#3 Variety

Longhair Smooth
#3 Gender

Male Female
#3 Color
#3 Markings
#3 DN Number
#3 Microchip Number
(if any)
#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
#3 Owner Phone Number

Area Code Phone Number
#3 Owner Email
example@example.com
Puppy # 4
#4 Registered Name
#4 Call Name
#4 Puppy Name or ID
#4 Variety

Longhair Smooth
#4 Gender

Male Female
#4 Color
#4 Markings
#4 DN Number
#4 Microchip Number
(if any)
#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
#4 Owner Phone Number

Area Code Phone Number
#4 Owner Email
example@example.com
Puppy # 5
#5 Registered Name
#5 Call Name
#5 Puppy Name or ID
#5 Variety

Longhair Smooth
#5 Gender

Male Female
#5 Color
#5 Markings
#5 DN Number
#5 Microchip Number
(if any)
#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
#5 Owner Phone Number

Area Code Phone Number
#5 Owner Email
example@example.com
Puppy # 6
#6 Registered Name
#6 Call Name
#6 Puppy Name or ID
#6 Variety

Longhair Smooth
#6 Gender

Male Female
#6 Color
#6 Markings
#6 DN Number
#6 Microchip Number
(if any)
#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
#6 Owner Phone Number

Area Code Phone Number
#6 Owner Email
example@example.com
Puppy # 7
#7 Registered Name
#7 Call Name
#7 Puppy Name or ID
#7 Variety

Longhair Smooth
#7 Gender

Male Female
#7 Color
#7 Markings
#7 Number
#7 Microchip Number
(if any)
#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
#7 Owner Phone Number

Area Code Phone Number
#7 Owner Email
example@example.com
Puppy # 8
#8 Registered Name
#8 Call Name
#8 Puppy Name or ID
#8 Variety

Longhair Smooth
#8 Gender

Male Female
#8 Color
#8 Markings
#8 DN Number
#8 Microchip Number
(if any)
#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
#8 Owner Phone Number

Area Code Phone Number
#8 Owner Email
example@example.com
Puppy # 9
#9 Registered Name
#9 Call Name
#9 Puppy Name or ID
#9 Variety

Longhair Smooth
#9 Gender

Male Female
#9 Color
#9 Markings
#9 DN Number
#9 Microchip Number
(if any)
#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
#9 Owner Phone Number

Area Code Phone Number
#9 Owner Email
example@example.com
Puppy # 10
#10 Registered Name
#10 Call Name
#10 Puppy Name or ID
#10 Variety

Longhair Smooth
#10 Gender

Male Female
#10 Color
#10 Markings
#10 DN Number
#10 Microchip Number
(if any)
#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
#10 Owner Phone Number

Area Code Phone Number
#10 Owner Email
example@example.com
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