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CERTIFICATE/PEDIGREE APPLICATION PRINT - FILL OUT AND SEND TO: NRTA 26 Park Drive Rocky Hill, CT 06067-1717 Phone 860-563-2293 Questions? E-mail nrta@cox.net Registration fees are listed below on the Fee Schedule. No Personal Checks Accepted Online Registration Form |
| SECTION A. Description of Dog
Breed of Dog___________________Sex_______Eye color_______________Nose color_____________ Coat color__________________________Date of Birth_______________________Weight_________ (Circle One) Patterns/Markings- 1.Tri-Colored 2.Patches of Color 3.Solid 4.White blaze-collar-boots-chest (Circle One) Type A____________Type B ___________ Breeders Kennel Name________________________Reg. #(if previously registered)_________________ Toy under 10lbs_______ Mini 10-18lbs________Standard 18-28lbs_______ Decker Giant 22-40lbs______ Name of Dog being recorded. Submit 2 different choices. Leave a space between words. If dog is already registered with another association, the name must remain the same. 1st choice ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __ 2nd choice ___ ___ ___ ___ ___ ___ ___ ___ ___
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City_____________________________________________State______________Zip_______________ Phone#________________________________Signature_______________________________________ Name of Co-Owner_________________________________Address_____________________________ City_____________________________________________State______________Zip______________ Phone#________________________________Signature______________________________________
Name of Breeder _____________________________________ Phone__________________________ Address_____________________________City_________________State________Zip____________ |
| SECTION D Fill in Sire and Dam information. In the Coat Color boxes below, write in ALL the colors of your dogs coat and circle the letter that best describes the dogs coat patterns/ markings. |
| Description of Sire
Breed of Dog______________________________Eye color_______________Nose color____________ Coat color__________________________Date of Birth_______________________Weight________ (Circle One) Patterns/Markings- 1.Tri-Colored 2.Patches of Color 3.Solid 4.White blaze-collar-boots-chest (Circle One) Type A____________Type B __________ Sire's Name________________________________Reg. #(if previously registered)__________________ Toy under 10lbs_______ Mini 10-18lbs________Standard 18-28lbs_______ Decker Giant 22-40lbs______ |
| Description of Dam
Breed of Dog______________________________Eye color_______________Nose color____________ Coat color__________________________Date of Birth_______________________Weight________ (Circle One) Patterns/Markings- 1.Tri-Colored 2.Patches of Color 3.Solid 4.White blaze-collar-boots-chest (Circle One) Type A____________Type B __________ Dam's Name_______________________________Reg. #(if previously registered)__________________ Toy under 10lbs_______ Mini 10-18lbs________Standard 18-28lbs_______ Decker Giant 22-40lbs______ |
Enter the letter for the type of pedigree/certificate requested from the Fee Schedule___.
FEE SCHEDULE