AKC R eunite M icrochip R egistration
Pet I nformation
Microchip # : _ _______________________________
Pet N ame: _ __________________________________
Or p lace b arcode s ticker h ere.
Species: ☐ D og ☐ C at ☐ O ther: _ _______________
Breed: _ _____________________________________
☐ M ale ☐ F emale S pay/Neutered: ☐ Y es ☐ N o
Pet’s V eterinarian
Date o f B irth: _ _______________________________
Name o f C linic: _ ______________________________
Color/Markings: _ _____________________________
Phone: _ ____________________________________
Registry ( if a pplicable): ☐ A KC ☐ O ther: _ _________
Registration # ( if a pplicable): _ ___________________
Primary C ontact I nformation
Communication P references
First N ame: _ _________________________________
Periodically, A KC R eunite w ill s end y ou i nformation
Last N ame: _ _________________________________
directly r elated t o y our p et’s e nrollment. P lease c heck
Address: _ ___________________________________
the i nformation y ou D O N OT w ant t o r eceive:
City: _ ____________________ S tate: _ ____________
☐ P romotions/ n ews f rom A KC R eunite
Zip: _ ______________ C ountry: _ ________________
☐ E -‐mail p romotions/news f rom A KC R eunite
Home P hone: _ _______________________________
☐ S hare m y i nformation w ith t hird p arties f or p et
Work P hone: _ _______________________________
related o ffers.
Mobile P hone: _ ______________________________
Text M essage E -‐mail: _ _________________________
Note: E nrollment i n A KC R eunite w ill h elp t o e nsure s afe
E-‐Mail: _ _____________________________________
return o f y our p et
Alternate C ontact I nformation
First N ame: _ _________________________________
Last N ame: _ _________________________________
Home P hone: _ _______________________________
Work P hone: _ ________________________________
Mobile P hone: _ ______________________________
E-‐Mail: _ _____________________________________
Note: E nrollment i n A KC R eunite w ill h elp e nsure s afe r eturn o f y our p et w hen f ound, b ut d oes n ot s ignify o wnership. P rices s ubject t o c hange.
AKC R eunite 8 051 A rco C orporate D rive, S uite 2 00 R aleigh, N C 2 7617 F ax 9 19-‐816-‐3828 w