Show/Conformation Title Application
Designer Breed Registry
All dogs participating in the Champion Certification program must be registered with the DBR.If your dog is not registered with the
DBR you may submit an individual application for registration with the required fee along with this application.
All video tapes and applications become the property of the Designer Breed Registry Certificate  will be
issued within 3 weeks of submission. Once your video has been approved any and or all fees are not refundable. All decisions of judges are final.
If your video is not approved you will not be charged.
Please print clearly
Check the title you are applying for: (   )CHAMPIONSHIP CERTIFICATE      (   )MERIT CHAMPION CERTIFICATE **

Breed:___________________________________________________________Registration #_________________________

**Dog Of Indefinite Ancestry Listing, dog of** Unknown Origin: Registration #___________________________________

Date of Birth________/________  Male(    )    Female(    )    
Neutered(    )   Spayed(    )
_
Name of Dog:_________________________________________________________________________________________

Owners Name:_________________________________________________________________________________________

Address:______________________________________________________________________________________________

City:________________________________________________State/Country:_________________Postal/Zip:_____________
One of our representatives will call you after the judges view your video

Best time to call___________________ Phone #_____________________________________


Method Of Payment:    (   ) Credit Card       (   )Check       (   ) Money Order      (   ) PayPal
Fee:Conformation Championship $165.00      Merit Championship $150.00

Name on credit card(please print):______________________________________________________________

Credit Card #___________________________________________________________Exp.Date_____/______
Cardholder authorizes this charge
Card Holders Signature:___________________________________________________Date:____/_____/____

Please mail to:                                  Printable Page or Copy and Paste
Designer Breed Registry
PO Box 63
Rosebush, Michigan 48878
Phone 1-732-256-9415