Canadian Kennel Club Application Form Page 2
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NOTE
2. Non-Breeding Agreement: If this dog will be registered on a Non-Breeding
1. Co-Ownership: If this dog will be registered to the seller(s) and a new owner,
basis, please complete CKC Non-Breeding Agreement Form (#101-05-05) and
please complete CKC Co-Ownership Form (#101-06-05) and attach to this
attach to this application.
application.
4. Any unused forms must be returned to The Canadian Kennel Club.
3. Any alterations on this form other than address changes require a written
explanation.
D TRANSFER SECTION
If the dog is sold or otherwise disposed of, complete this Transfer Section. Fees are assessed on all transfers of ownership.
Please note: When completing Transfer Section, be specific in "Title" section (i.e. Mr., Mrs., Ms, DR.)
D
M
Y
D
M
Y
Date the new owner
Breeding and/or
Date of Transfer/
House pet
Dog sold for
took possession of the dog
exhibiting purpose
Date of Sale
OWNER(S)
Title
Last Name
CKC Membership Number
)LUVW 1DPH
Last Name of New Owner #1
)LUVW 1DPH
Title
Last Name
CKC Membership Number
Last Name of New Owner #2
)LUVW 1DPH
Title
Last Name
CKC Membership Number
Last Name of New Owner #3
)LUVW 1DPH
Title
Last Name
CKC Membership Number
Last Name of New Owner #4
Complete Mailing Address for Owner #1 (include Street Number, Unit number, etc.)
Prov
Postal Code
Apartment/Unit
City
Telephone Number
Email Address
E
I / we certify that all of the information contained in this application is true and may be verified upon request.
Signature of Owner # 1 at Birth
Date
Signature of Owner # 3 at Birth
Date
Signature of Owner # 2 at Birth
Date
Signature of Owner # 4 at Birth
Date
To verify information during normal business hours, contact me at
_
)
(
CKM-620B
Payment Options
Visa
Mastercard
Cheque
Bill Memeber Account
Clearly Print Cardholder Name
Credit Card Number
$
.
Authorized Cardholder Signature
Amount:
Expiry Date:
For Office Use Only
101-02-05 (04/04) CANADACHIP
TM
is a trademark of The Canadian Kennel Club
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