PPPA Futurity Puppy Nomination Form (Part 2a)

PART 2a: Please fill out one form PER puppy. MUST BE COMPLETE 2 months prior to Futurity Stake.

Required fields marked Submission to: Bekki Pina (kaijekennels@yahoo.com)

Puppy Nomination

1. Did you submit Part 1 (Bitch nomination) prior to bitch being whelped? Required

Yes No (Not eligible to enter these Stakes with this puppy)

2. Are you a PPPA member? Required

Yes No

3. AKC Registered Name (or Name Applied For): Required

4. AKC Registration Number (or Litter Number): Required

5. Microchip or Tattoo of Puppy Required

6. Coat type: Required

Smooth Wire

7. Gender Required

Dog Bitch

8. Whelping Date: Required

Please input date (M/d/yyyy).

9. AKC Registered Name of Dam: Required

10. AKC Number of Dam: Required

11. AKC Registered Name of Sire: Required

12. AKC Number of Sire: Required

13. Name of Owner: Required

14. Name of Breeder (Or Lessee) Required

15. Email address of owner: Required

16. Address of Owner: Required

17. I acknowledge this puppy nomination has been submitted at least 2 months prior to the PPPA National Futurity Stake. Required

Yes

18. By typing your full name below, I electronically agree that all the above is accurate to the best of my knowledge: Required