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IBR Application

Name *

Date Of Birth *

(mm/dd/yyyy)

Gender *

Male
Female

Sire Name *

Dam Name *

Breed *

Color & Specific Marking Description *

Current Registration *

UKC
AKC
ABKC
USBR
Other

(Select One)

REG # *

Name *

First

Middle

Last

(Owner Information)

Address *

City *

State *

Zip *

Phone Number *

Email *

Confirm Email

___________________________________________________________________

3-GENERATION PEDIGREE

Must provide a copy of your 3-GENERATION PEDIGREE. Information must be visible *SEE EXAMPLE BELOW*

Front Copy *

Inside Copy *

___________________________________________________________________

Shipping Method *

Standard ($15)
Rush Service ($35)

(PROCESSED WITHIN 5 BUSINESS DAYS OF RECEIPT AT IBR / DOES NOT INCLUDE TIME IN TRANSIT) **NO REFUND WILL BE ISSUED DUE TO AN INCOMPLETE APPLICATION**

Dog Fees *

Dog up to 1 Year of Age ($30)
Dog over 1 Year of Age ($45)

Total

$ 0.00

BY FILLING THIS FORM YOU ACKNOWLEDGE AND AGREE THAT YOU ARE THE CURRENT OWNER OF THE FOR MENTIONED REGISTERED DOG AND ALL INFORMATION PROVIDED IS TRUE AND ACCURATE. IBR RESERVES THE RIGHT TO DENY AND/OR TERMINATE REGISTRATION AT ANY TIME IF AND INFORMATION IS PROVEN FALSE. IF YOU ARE DENIED OR REGISTRATION IS TERMINATED, ALL FEE’S PAID WILL BE FORFEITED.

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