DOBERMAN PINSCHER CLUB OF AMERICA INC.    

Futurity - Puppy Nomination Form
Futurity Year _________

Please Print Plainly-Must Be Legible

AKC Reg. Name _____________________________________   AKC Reg. No.________________________
[Reg.Name and Reg. No. must be supplied as soon as available and in no case later than three (3) weeks before the stake judging.]

Whelping Date__________________________     Sex______________     Color____________________

Sire________________________________________  Dam________________________________________

Name of Breeder__________________________________________________ Phone__________________

Name of Person(s) [Owner(s)] under whom Puppy will be entered in Catalogue  ________________________

_________________________________________________________________________________________

Address__________________________________________________________________________________

Signature of Owner or Agent__________________________________________ Date _________________

Address__________________________________________________________________________________

E-Mail Address:  __________________________________________________ Phone__________________

Enclosed $_________  Make checks payable to DPCA   [Payable in US Dollars Only,  Cancelled Check Will Be Your Receipt]
Fee: $15.00 for DPCA members, $25.00 for nonmembers will complete eligibility of each puppy's nomination for the futurity.
Mail the above form with fee to Futurity Chairman:  
Diane Simmons  2631 Riding Ring Road  Norco, CA 92860-2531  (951) 737-6978   E-Mail: dksimmons1@aol.com

Print THREE Forms:
Copy 1 - will be held by Futurity Chairman
Copy 2 - will be sent to you marked "Accepted" when in order
Copy 3 - will be held by you for your records

NOTE: Puppy Nomination Forms must be postmarked before the puppy is four months old. (see Futurity Stakes Rules)  Ck# ______________   Amt. ______________    Postmarked ______________  Processed ______________  Accepted ______________  Rejected ______________

Rev. 03/2006