Pre-Registration Request

Mail To Breeding Office:

Chris Weihs

PO Box 2203

Cashiers, NC 28717

Breeders Name and Address:__________________________________________________

(First, Middle Initial, Last Name)

__________________________________________________

(Street)

__________________________________________________

(City, State, Zip)

DWNA Kennel Name: ___________________________________________________________________

Dam: _________________________________________________________________________________

Sire: _________________________________________________________________________________

Breeding Date
Whelp Date
Born
Still Born
Died After Birth
# To Register
M
F
M
F
M
F
M
F

M/F
DWNA #
Pup Name
Color
Buyers Name & Address

Breeder's Signature: __________________________________ Date: ______________________