Lom Sire Application

ACKCSC LOM SIRE APPLICATION

Registered Name(Required)

Date of Birth (MM/DD/YYYY)(Required)

Name of Owner(s)(Required)

Address

City

State

Zip

E-mail(Required)

Name of Breeder(s)(Required)

Breeder E-mail(Required)

ROM #1(Required)

ROM #2(Required)

ROM #3(Required)

Additional Plaque(s) $65 each

Attach 300 dpi .jpg Photo

Max. file size: 8 MB.

Attach 300 dpi .jpg Photo

Max. file size: 8 MB.

Attach 3-Generation Pedigree AKC & AKC Recognized Titles Only (.pdf or .jpg only)

Max. file size: 8 MB.