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 or IMR_____________________________________________________________________
REGISTERED NAME OF DAM: ________________________________________________________________________________
REGISTERED NUMBER OF DAM: CMA or IMR_____________________________________________________________________
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:
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:
State:
______________________________ Zip: ________________ Phone: (________) ______________________
WITNESS OF BREEDING
IF OWNER OF SIRE OR DAM DID NOT WITNESS THE BREEDING:
Name & Signature
of Witness: ______________________________________________________________________________
To register a litter with the CMA, Inc.: dam must be “A” Perm. Reg.
with CMA and sire must be registered with either CMA, Inc. or IMR and a
completed CMA, Inc. “Litter” Health Data Base Form must accompany Litter
Application. Litter registration application with $15.00 fee must be postmarked
within four (4) weeks from whelping date or an additional $40.00 late fee with
explanation will be required
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
CMA Update (01-07-05) 3128 Winberry
Drive,