PO Box 292543 Nashville, TN 37229 Individual Dog Registration This form can be used to register as many dogs as desired at one time. If more than one dog is being registered simply print and complete as many forms as needed. The registration fee is based on the number of dogs being registered at one time to a single owner. Fee Schedule: 1 dog $35, 2 dogs $60, 3 dogs $75, 4 dogs $90, 5+ dogs $100 An additional discount up to 20% for pedigrees is provided in the form of a rebate. Rebate is based on individual pedigrees calculated on an individual dog basis. To qualify for rebate the pedigrees MUST BE from another official registry. Private pedigrees and online pedigrees do not count toward rebates. Whether official or private held all known genealogy data should be provided for research purposes. The more you provide us the more we can research and use to enhance your material. An fill-in pedi- gree template is available at the end of this form. If submitting an official pedigree from another regis- try it MUST BE a photocopy with all names and numbers included, complete and legible. If pictures of relatives may also be included to enhance your material. Referred By: Check here if you wish to sign up as a Certified Kennel If signing up as a Certified Kennel you can provide up to 4 options in the event a kennel name is already taken. 1. 2. 3. 4. Owner Information: Please list only one primary owner. First Name: Last Name: Mail Address: Apt/Lot: City: State/Province: ZIP/Postal Code: Country (if outside USA): Phone: ( ) Cell Phone:( ) Your email(s) if available is extremely important as it is used to set up your social account and a primary method of contact. Email: Alt Email: Dog Information: Dog Name: Male OR Female Birth Date: Sire/Father (if known): ABA # if ABA Registered: Dam/Mother (if known): ABA # if ABA Registered: Please circle the appropriate breed. American Bully Alano Espanol Alapaha Blue Blood Bulldog Alp Mastiff American Bulldog American Pit Bull Terrier American Staffordshire Terrier Bandog / Bandogge Boerboel / South African Mastiff Boston Terrier Boxer Brazilian Bullmastiff Bullmastiff Bull Terrier Bully Kutta / Pakistani Mastiff Cane Corso / Italian Mastiff Cao de Fila de Sao Miguel Catahoula Bulldog Catahoula Leopard Dog Cimarron Uruguayo Dabba Kutta Doberman Pinscher Dogo Argentino / Argentinian Dog Dogo Guatemalteco Dogue de Bordeaux / French Mastiff Dosa Inu / Mee-Kyun Dosa English Bulldog English Mastiff Fila Brasileiro / Brazilian Mastiff French Bulldog Gran Mastín de Borinquen Great Dane / German Mastiff Greater Swiss Mountain Dog Gull Dong Gull Terrier Khowaty Bull Terrier Neapolitan Mastiff Olde English Bulldogge Presa Canario Pug / Dutch Mastiff Rhodesian Ridgeback Rottweiler Shar-Pei Sindh Bully / Sindh Mastiff Staffordshire Bull Terrier Tosa Inu / Japanese Mastiff If other than breed listed: If your dog is in a developing breed and parents are of two different breeds please list accordingly for proper breed notation and genealogy tracking. Example: Father - American Bully X Mother - American Pit Bull Terrier Father Breed: X Mother Breed: A Front and Side picture is REQUIRED of all dogs being ABA registered. Please noted how you are providing these. Pics included with mailed forms Pics emailed to [email protected] Fee Schedule: 1 dog $35, 2 dogs $60, 3 dogs $75, 4 dogs $90, 5+ dogs $100 Please mark the box indicating the type of payment arrangements being made. Online debit/credit, check Money Order PayPal OR Bitcoin If paying online you may use this link: http://AmericanBullyAssociation.com/payment.html OR If you have a mobile phone with QR code reader you may use the following QR code to the right. Your submission is your testimony to purity if being submitted under an established breed. If submitting under a developing breed you are testifying that your dog meets the criteria to be considered in the developing breed category of your choosing. Failure to follow this criteria for registration is considered fraud and punishable through civil and criminal litigation. You are additionally agreeing that if any litigation is necessary that you will be held liable for all damages and legal fees to all parties. Signature Date Pedigree Template 32. 16. 33. 8. 34. 17. 35. 4. 36. 18. 37. 9. 38. 19. 39. 2. 40. 20. 41. 10. 42. 21. 43. 5. 44. 22. 45. 11. 46. 23. 47. 1. 48. 24. 49. 12. 50. 25. 51. 6. 52. 26. 53. 13. 54. 27. 55. 3. 56. 28. 57. 14. 58. 29. 59. 7. 60. 30. 61. 15. 62. 31. 63. Pedigree Format Guideline 8. SSS 4. Sire's Sire 9. SSD 2. Sire (Father) 10. SDS 5. Sire's Dam 11. SDD 1. Registering Dog Etc. As Needed 12. DSS 6. Dam's Sire 13. DSD 3. Dam (Mother) 14. DDS 7. Dam's Dam 15. DDD If unable to complete in the table provided you can alternatively provide the genealogy numerically using the pedigree format as a guide. 1. Registering Dog 2. Sire 3. Dam 4. Sire's Sire 5. Sire's Dam Upon Completion this guide can be either uploaded as part of the registration process or can 6. Dam's Sire alternatively be emailed to us directly at: [email protected] 7. Dam's Dam 8+ Etc..