IWC Individual Dog Registration Application

Date

Must use mm-dd-yyyy format, or use calendar icon to choose date

Owner Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country

Best Phone Number

Area CodePhone Number

Email

example@example.com

Registered Name

Call Name

Breeder

Birthdate

Date

Variety

Gender

Color

Markings

Embark SWAB Number (if Embark tested)

If not Embark, what laboratory did the DNA testing?

DNA Number from a lab other than Embark:

Microchip Number

(if any)

MDR1

CEA

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

Sire's Registered Name

Sire's Registration Number

Sire's Embark swab # (if Embark tested) or DNA # from another Lab)

Dam's Registered Name

Dam's Registration Number

Dam's Embark swab # (if Embark tested) or DNA # from another Lab)

Please send copies of MDR1 & CEA Lab Reports
If BOTH parents are N/N (+/+ or A) for MDR1 and/or CEA, send the PARENTS lab reports unless they are already on file with Registrar.
If one or both parents are smooth coated Windsprites, send copies of FGF5 coat length test results.
If dog is registered in another registry, send copy of registration certificate and certified pedigee.
If dog is NOT registered in another registry, send a complete 4 generation pedigree with formal names and any known registration numbers for those ancestors.
DNA Parentage verification provided by a certified genetic testing laboratory is also required.

Send all lab reports, registration certificates, pedigree, parentage verification and any questions to Treasurer4IWC@gmail.com

Fees

Fees to be Paid via:

Please enter any comments or additional information