FEE $25 (U.S. Funds Only)

(Please Print)

Name of Kennel or Cattery _________________________________

Address _______________________________________________

City __________________________________________________

State and Zip ___________________________________________

Owner of Kennel or Cattery (Print) ___________________________

I am applying to American Purebred Registry to register my kennel or cattery name for the purpose of insuring that no other person can use my registered kennel or cattery name to register dogs or cats with American Purebred Registry without my written permission. I understand that this registration does not take the place of registration of trademark or patent or DBA or any other licensing agency in my town, city, state or country and does not give me permission to operate a business and does not state that I am licensed to breed dogs or cats.

_____________________________________   _________________
Signature                                                                        Date

Your Kennel or Cattery Name will be reproduced on a 8 1/2 X 11 gold lithographed certificate that will look great framed and hanging on your wall. It will be something you can proudly show your friends and clients.