Obedience Title Application
All dogs participating in the Obedience 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/
DVD's 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. Video can
not be longer than 20 minutes.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 see fee schedual and link for requirements for titles at bottom of page:
( )CD 1 ( )CD2 ( )CD3 ( )CC ( )CCM ( )TD ( ) AC ( )ACE
Breed: Registration# Date of Birth M F
_______________________________________ ________________________ ______/_____/________ [ ] [ ]
Tatoo or Microchip# if applicable Name of Dog:
_______________________________________ ____________________________________________________
Owners Name: Co Owners Name:
_________________________________________________ ___________________________________________
Address: City State/Country
:______________________________________ _______________________ _____________________________
Postal/Zip Phone # Email
:__________________ ____________________________ ____________________________________________
Best time to call______________ One of our representatives will call you after the judges view your video
Method Of Payment:
( ) Credit Card ( )PayPal( )Check ( ) Money Order Total Fee: $____________as stated below
Name on credit card(please print):______________________________________________________________
Credit Card # Exp.Date cvs code
___________________________________________________________ _____/_____/_____ ____________
Cardholder Signature below authorizes this charge
___________________________________________________Date:______/_____/______
Fees For Testing are as follows PLEASE see the link or for requirements for each title:
CD 1 - Companion Dog Level 1 - $45.00 CC - Canine Citizen - $45.00 AC - Agility Canine - $45.00
CD 2 - Companion Dog Level 2 - $45.00 CCM - Canine Citizen of Merit - $45.00 ACE - Agility Canine Excellent - $45.00
CD 3 - Companion Dog Level 3 - $45.00 TD - Tracking Dog - $45.00
Please mail video/DVD and payment to:
Designer Breed Registry
PO Box 474
Farmingdale, New Jersey 07727
732-256-9415
Copy and paste or print page
All dogs participating in the Obedience 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/
DVD's 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. Video can
not be longer than 20 minutes.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 see fee schedual and link for requirements for titles at bottom of page:
( )CD 1 ( )CD2 ( )CD3 ( )CC ( )CCM ( )TD ( ) AC ( )ACE
Breed: Registration# Date of Birth M F
_______________________________________ ________________________ ______/_____/________ [ ] [ ]
Tatoo or Microchip# if applicable Name of Dog:
_______________________________________ ____________________________________________________
Owners Name: Co Owners Name:
_________________________________________________ ___________________________________________
Address: City State/Country
:______________________________________ _______________________ _____________________________
Postal/Zip Phone # Email
:__________________ ____________________________ ____________________________________________
Best time to call______________ One of our representatives will call you after the judges view your video
Method Of Payment:
( ) Credit Card ( )PayPal( )Check ( ) Money Order Total Fee: $____________as stated below
Name on credit card(please print):______________________________________________________________
Credit Card # Exp.Date cvs code
___________________________________________________________ _____/_____/_____ ____________
Cardholder Signature below authorizes this charge
___________________________________________________Date:______/_____/______
Fees For Testing are as follows PLEASE see the link or for requirements for each title:
CD 1 - Companion Dog Level 1 - $45.00 CC - Canine Citizen - $45.00 AC - Agility Canine - $45.00
CD 2 - Companion Dog Level 2 - $45.00 CCM - Canine Citizen of Merit - $45.00 ACE - Agility Canine Excellent - $45.00
CD 3 - Companion Dog Level 3 - $45.00 TD - Tracking Dog - $45.00
Please mail video/DVD and payment to:
Designer Breed Registry
PO Box 474
Farmingdale, New Jersey 07727
732-256-9415
Copy and paste or print page
DESIGNER BREED REGISTRY®
