UDC Dog Registration Form

Please mail this registration form along with:

UDC Registry
UDC Registry
c/o Linda Kurz
3640 Yellow Dog Road
Lonedell, MO 63060
Home Telephone: (636)629-4553
UDC Registry email address: registry@uniteddobermanclub.com

Information Required For Registration:

Your Name
__________________________________________________________________________________

Your Address
__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________


Home Phone (____) ____ _____       Work Phone (____) ____ _____

Email Address (if available)
_________________________________________________________________________

Personal Website Address (if available)
_________________________________________________________________________


Please supply the following information for EACH dog you wish to register
($40.00 fee for each dog).

Dog's Registered Name 
__________________________________________________________________________________

___________________________________________________________________________________

Color
_____________________________________________________

Sex _________________________________________________

Date Whelped __________________________________________

AKC# ________________________________________________

CKC# ________________________________________________

Tattoo#  (if available)___________________________________

Microchip # (if available) ________________________________

Breeder
_________________________________________________________________________________

_________________________________________________________________________________


Health Statistics (must be documented) __________________________________________

_________________________________________________________________________________


Title or Championships (must be documented) _____________________________________

_________________________________________________________________________________

_________________________________________________________________________________


Other registries in which the dog is entered (Document? Number?) ________________

_________________________________________________________________________________

_________________________________________________________________________________


Enclose a copy of pedigree (certified, if possible) _____________________________




Total Enclosed  $__________________

UDC is now accepting payment by Visa and Mastercard. Accounts will be
debited in $US. Please provide the following information:

Visa_____      Mastercard _____


_______________________________________________ Card Number


______________________________ Card Expiry Date


_______________________________________________Cardholder's Signature

Back to the UDC Doberman Registration Page
Back to the UDC Home Page.