Futurity Litter Nomination

Date Whelped*
# Dogs - Blue Merle
# Dogs - Black
# Dogs - Red Merle
# Dogs - Red
# Bitches - Blue Merle
# Bitches - Black
# Bitches - Red Merle
# Bitches - Red
Dam’s Registered Name*
Dam’s AKC #*
Sire’s Registered Name*
Sire’s AKC #*
Litter Owner*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Co-Owner(s)
Futurity Year*
Certify Information*
I nominate the above Litter for the year above in the Roger McKay Breeder Futurity. I hereby certify that the above information is correct, the Litter is eligible for the Futurity, and I have read and agree to abide by the Futurity Rules & Regulations. Litter entry fee, made payable to USASA, as noted below is enclosed with this form.
Litter Nomination Fee*
- Litters up to 1 month of age ($25)
- Litters up to 2 months of age ($100)
- Litters up to 3 months of age ($200)
Litter nominations for puppies over 3 months of age will not be accepted.
Total
$0.00

United States
Australian Shepherd Association