Rom Dam Application

ACKCSC ROM DAM APPLICATION

AKC Name(Required)

AKC Number

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

Name of Owner(s)(Required)

Address

City

State

Zip

Email(Required)

Name of Breeder(s)(Required)

Breeder E-mail(Required)

Champion 1(Required)

Champion 2(Required)

Champion 3(Required)

Champion 4(Required)

Champion 5(Required)

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

Max. file size: 8 MB.

Attach 300 DPI .jpg Photo

Max. file size: 8 MB.

Additional Plaque(s) $65 each