Embryo Transfer Enrollment
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1Embryo Transfer Enrollment
FOR FEDEX DELIVERY TO AQHA: 1600 QUARTER HORSE DR, AMARILLO, TX 79104 • MAILING ADDRESS: P.O. BOX 200, AMARILLO, TX 79168
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( 806 ) 376-4811 •
( 806 ) 349-6405
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( 806 ) 373-2281
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FAX:
This is notification of the intent to transfer an embryo from the mare below.
This form and enrollment fee must be submitted to AQHA before the collection of an embryo. The enrollment, once complete, is not transferable
or refundable. Only one enrollment per year is required, regardless of the number of embryos being transferred. Refer to rule 212 for a complete
listing of embryo transfer requirements.
MARE’S NAME
REGISTRATION NUMBER
●
LIFETIME ENROLLMENT:*
YES
OR ENROLL FOR ONE BREEDING SEASON
BREEDING SEASON YEAR
Before a resulting foal can be registered, its parentage must be verified by genetically testing the donor mare, sire and foal. If the mare has
not been tested, you may order a DNA kit below.
The person signing below agrees to pay all genetic testing expenses for the parentage case of the resulting foal.
By submitting this document to AQHA, I hereby agree to be bound by all the terms and conditions of AQHA’s Official Handbook of Rules
and Regulations.
SIGNATURE OF PERSON AGREEING TO PAY EXPENSES
DATE SIGNED (MM/DD/YYYY)
AQHA ID#
PRINTED NAME OF PERSON AGREEING TO PAY FOR EXPENSES
ADDRESS
COUNTRY
STATE/PROVINCE
CITY
ZIP CODE
TELEPHONE
E-MAIL
Please provide the name and AQHA identification number of the clinic where the transfer will be performed
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CLINIC NAME AND ADDRESS
AQHA ID #
** If a mare is enrolled for her lifetime, all of her offspring must be parentage verified before they can be registered regardless of the breeding method used.
** For the member fee to apply, the recorded owner of the donor mare must be an AQHA member. Membership can be purchased at the time of this
transaction to receive the member fees.
FEES
●
●
IF PAYING BY CREDIT CARD, PLEASE COMPLETE THE FOLLOWING:
FEES SUBJECT TO CHANGE WITHOUT NOTICE.
CHECK
MONEY ORDER
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●
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Member
Non-Member
AMERICAN EXPRESS
MASTERCARD
VISA
O
$500
$540
Lifetime enrollment
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
O
$100
$140
Annual enrollment
CARD NUMBER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
O
$25
N/A
Late penalty, before breeding
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . .
EXP. DATE (MMYY)
DAYTIME PHONE
O
$50
N/A
Late penalty, after breeding
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . .
O
$50
N/A
DNA Kit
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . .
CARDHOLDER NAME
Dues payments MAY BE deductible by members as an ordinary and necessary business expense; however,
contributions or gifts to the American Quarter Horse Association are not deductible as charitable contributions
CARDHOLDER SIGNATURE
for federal income tax purposes. However, donations to the American Quarter Horse Foundation ARE tax-
SUBSCRIBE ONLINE AT
deductible to the extent allowed by law. $1 of your annual membership dues is designated for a subscription to
SUBCRIBING TO THE JOURNAL WILL KEEP YOU
America’s Horse, AQHA’s official member publication. Through the payment of a membership fee to AQHA, I
UPDATED ON THE AMERICAN QUARTER HORSE INDUSTRY.
acknowledge that membership in AQHA is voluntary and I agree to be bound by all the terms and conditions of
AQHA’s Official Handbook of Rules and Regulations.
DO NOT SEND CASH • U.S. FUNDS ONL Y
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