AMERICAN RARE BREED MI-KI REGISTRY
PUREBRED MI-KI LITTER REGISTRATION APPLICATION

PLEASE READ ALL THE INSTRUCTIONS ON THE REVERSE SIDE BEFORE COMPLETEING THIS APPLICATION. PRINT ALL INFORMATION (except signature). USE BLACK INK AND CAPITAL LETTERS WHEN FILLING OUT THIS APPLICATION.

Make all check payable to (ARBMR) Registrar Lawrie Willis

Mail to: AMERICAN RARE BREED MI-KI REGISTRY 209 Lee Ridge Road SE Cleveland, TN 37323

LITTER REGISTRATION FEE: $15.00 DO NOT SEND CASH

SIRE’S REGISTRATION NAME: __________________________________________________________
SIRE’S REGISTRATION NUMBER: ______________________ SIRE’S DNA #: _______________
NAME OF REGISTRY THE SIRE IS REGISTERED WITH AT TIME OF BREEDING: ______________________
SIRE’S OWNER AT THE TIME OF BREEDING: _______________________________________
Address: _______________________________________ City: ___________________ State: ____ Zip: _________
Home Phone: _______________ Cell: _______________ Email: ___________________________________________
I certify that the sire listed above was bred to the dam listed below and that the sire was owned by me on the date of breeding.
I ___ witnessed ___ did not witness the breeding of this sire and this dam. (Owner of Sire must initial one)

This litter is the result of a ___ Natural Breeding or ___ Artificial Insemination
Signature of Sire’s Owner: _______________________________________ ___/___/20___
DAM’S REGISTRATION NAME: __________________________________________________________
DAM’S REGISTRATION NUMBER: ______________________ DAM’S DNA #: _______________
NAME OF REGISTRY THE DAM IS REGISTERED WITH AT TIME OF BREEDING: ______________________
DAM’S OWNER AT THE TIME OF BREEDING: _______________________________________
Address: _______________________________________ City: ___________________ State: ____ Zip: _________
Home Phone: _______________ Cell: _______________ Email: ___________________________________________
I certify that I am the owner of the above named dam on the date of birth of the litter and that this dam was not bred to any other dog during her season. I apply to register this litter and further certify that all information on this application is true. I ___ witnessed ___ did not witness the breeding of this sire and this dam. (Owner of Dam must initial one)

This litter was the result of a ___ Natural Breeding or ___ Artificial Insemination
Signature of Dam’s Owner: _______________________________________ ___/___/20___
Breeding Date(s): __________________________________________________________
Location of Breeding(s): (City) _________________________________ (State) _____
Date of Whelp: _________________
Location of Whelp: (City) _____________________________ (State) _____
Number of total ____ Males ____ Females born
Number of live Puppies: ___ Males ___ Females
Number of Puppies Born Dead: ___ Males ___ Females
Number of Puppies that Died after Whelp: ___ Males ___ Females
If there were puppies born dead or that died later, what was the reason for their death? ________________________________________________________________________________________________________________________
Did you have a necropsy done on the dead puppy or puppies? ___ Yes ___ No (If you had a necropsy done, please attach the documentation from your veterinarian explaining the findings of the necropsy.)

Instructions for Completing ARBMR's Purebred Mi-Ki Litter Registration Application
1. ALL INFORMATION: If we cannot read all information requested, the application will be returned to you. This will delay your litter registration certificates.
2. If the ARBMR finds, at any time, that the owner misrepresents any information on this registration application, or misrepresents their Mi-Kis or the Mi-Ki breed, this will be considered cause for cancellation and will result in loss of all ARBMR privileges.
3. Sire and Dam must be registered with the ARBMR or with another ARBMR recognized Mi-Ki registry. Sire and Dam must be recorded with the ARBMR in the person(s) name who was the actual owner(s) on the dates when the breedings and birth accrued, before this application is submitted.
4. Litters eligible for registration with the ARBMR MUST be registered in owner’s name only.
5. Failure to sign and date this application or incorrect fee amount will result in delay of processing this Litter Registration application.
6. If this application is accepted, the ARBMR will send the litter owner one individual registration certificate for each puppy in the litter. These individual registration certificates should be furnished AT THE TIME ownership of the puppy is transferred.
7. The owner of the litter must have this application submitted to the ARBMR by the time that the litter is 4 weeks of age. If application has not been submitted to the ARBMR by the time the litter is 4 weeks of age, an additional $5.00 per week will be due to the ARBMR in addition to the $15.00 Litter Registration Fee.
8. If you have any questions regarding this registration application, please contact ARBMR at 209 Lee Ridge Road SE Cleveland, TN 37323 or 423-479-3851 or send an e-mail message (include your phone number) to ARBMR Email .
Registration Form (7/7/2007)

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