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*

LonghairSmooth

Gender*

MaleFemale

Color*

Markings

Embark swab Number (if Embark tested)

Microchip Number

(if any)

MDR1*

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

CEA*

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

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

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

Sire's Registered Name

Sire's Registration Number

Sire's Embark swab # (if Embark tested)

Dam's Registered Name

Dam's Registration Number

Dam's Embark Swab # (if Embark tested)

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

Registration with Registration Certificate$15.00

Add Certified Pedigree (optional)$5.00

International Postage (if outside USA)$5.00

Total $0.00

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