| Show/Conformation Title Application Designer Breed Registry |
All dogs participating in the Champion Certification program must be registered with the DBR.If your dog is not registered with the
DBR you may submit an individual application for registration with the required fee along with this application.
All video tapes and applications become the property of the Designer Breed Registry Certificate will be
issued within 3 weeks of submission. Once your video has been approved any and or all fees are not refundable. All decisions of judges are final.
If your video is not approved a processing fee of $20.00 will not be refunded.
Please print clearly
Check the title you are applying for: ( )CHAMPIONSHIP CERTIFICATE ( )MERIT CHAMPION CERTIFICATE
Breed:_______________________________________________Registration #_________________________
Dog Of Unknown Origin: Registration #_______________________________
Date of Birth____/_____/________ Male( ) Female( ) Neutered( ) Spayed( )
_
Name of Dog:_____________________________________________________________________________
Owners Name:____________________________________________________________________________
Address:__________________________________________________________________________________
City:________________________________________________State/Country:___________________Postal/Zip:_________________
One of our representatives will call you after the judges view your video
Best time to call___________________ Phone #_____________________________________
Method Of Payment:
( ) Credit Card ( )Check ( ) Money Order Fee:$125.00 check the coupons page for available promotions
Name on credit card(please print):______________________________________________________________
Credit Card #___________________________________________________________Exp.Date_____/______
Cardholder authorizes this charge
Card Holders Signature:___________________________________________________Date:____/_____/____
Please mail to: Printable Page or Copy and Paste
Designer Breed Registry
PO Box 474
Farmingdale, New Jersey 07727
Phone 1-732-256-9415
DBR you may submit an individual application for registration with the required fee along with this application.
All video tapes and applications become the property of the Designer Breed Registry Certificate will be
issued within 3 weeks of submission. Once your video has been approved any and or all fees are not refundable. All decisions of judges are final.
If your video is not approved a processing fee of $20.00 will not be refunded.
Please print clearly
Check the title you are applying for: ( )CHAMPIONSHIP CERTIFICATE ( )MERIT CHAMPION CERTIFICATE
Breed:_______________________________________________Registration #_________________________
Dog Of Unknown Origin: Registration #_______________________________
Date of Birth____/_____/________ Male( ) Female( ) Neutered( ) Spayed( )
_
Name of Dog:_____________________________________________________________________________
Owners Name:____________________________________________________________________________
Address:__________________________________________________________________________________
City:________________________________________________State/Country:___________________Postal/Zip:_________________
One of our representatives will call you after the judges view your video
Best time to call___________________ Phone #_____________________________________
Method Of Payment:
( ) Credit Card ( )Check ( ) Money Order Fee:$125.00 check the coupons page for available promotions
Name on credit card(please print):______________________________________________________________
Credit Card #___________________________________________________________Exp.Date_____/______
Cardholder authorizes this charge
Card Holders Signature:___________________________________________________Date:____/_____/____
Please mail to: Printable Page or Copy and Paste
Designer Breed Registry
PO Box 474
Farmingdale, New Jersey 07727
Phone 1-732-256-9415
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