THE CONTINENTAL MI-KI ASSOCIATION, INC. LITTER REGISTRATION APPLICATION
(Print or type clearly using ink only!
  Be sure all information is correct!)

THIS LITTER IS A RESULT OF:   _____ Natural breeding      _____ Artificial insemination

PLACE LITTER WHELPED:  City: _________________________ __State:____ ________ Zip: _________

NUMBER OF PUPS BORN:  LIVE MALES: ______ LIVE FEMALES: ______ DEAD MALES: _____ DEAD FEMALES: _____

DATE LITTER WHELPED: Month: (_____) Day (_____) Year (_________)

REGISTERED NAME OF SIRE:_________________________________________________________________________________

REGISTERED NUMBER OF SIRE:  CMA:_________________________________CDHPR:____________________________________

REGISTERED NAME OF DAM: ________________________________________________________________________________

REGISTERED NUMBER OF DAM:  CMA:__________________________________CDHPR:___________________________________

THE OWNER OF SIRE AT THE TIME OF MATING COMPLETES THIS SECTION:

    I certify that the above named Dam was bred to the above named Sire and that the Sire was owned by me on the date of breeding.

____ I did witnessed this breeding          ____ I did not witness this breeding

Name of Owner of Sire:_________________________________________________________

Signature of Owner of Sire:______________________________________________________

Street: ___________________________________________________________City:____________________

State: _____________________________ Zip: ________________ Phone: (________) ________________

THE OWNER OR LESSEE OF DAM ON DATE OF BIRTH COMPLETES THIS SECTION:

(Lessee of Dam must send completed Lessee Approval Form with Litter Registration)

Date(s) of breeding: Month (______) Day(s) (______________) Year (__________)

_____ I did witness this breeding            _____ I did not witness this breeding

Name of Owner or Lessee of Dam:______________________________________________________

Signature of Owner or Lessee of Dam:___________________________________________________

(Please print the address of the breeder to whom the puppy registration certificates will be mailed.)

Street: ____________________________________________________________City:__________________________

State: ______________________________ Zip: ____________ Phone:(_____)________________

WITNESS OF BREEDING IF OWNER OF SIRE OR DAM DID NOT WITNESS THE BREEDING:

Name & Signature of Witness:______________________________________________________________________

CMA Litter Registration fee is $8.00. Individual Puppy Registrations can be requested for $2.00 each. Completed CMA Health Data Base Litter Questionnaire must accompany all Litter Applications. Once the Litter Application & HDB Litter Questionnaire is received and approved "Available Puppies" will be posted on the owners listing, CMA breeder website page.

Please make all checks or money orders in U.S. dollars payable to:
  THE CONTINENTAL MI-KI ASSOCIATION, INC.
Mail all Forms & Fees to:
CMA, Inc. Treasurer, C/O Diana Rabb, 3128 Winberry Drive, Franklin TN 37064
: 

CMA Update (06-01-11)