Do you certify that you are the owner of the dog listed below and that all the information provided is true and accurate. Yes No
Name
Address
City
State		Outside USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Country
Phone
Email
Dog Information
Name of Dog
Breed
Date of Birth		January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Sex		Male Female
Color & Markings
Sire
Dam
Was dog previously registered?		Yes No
If yes, which registry?
Inspected by
Inspection date		January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Guidelines

• A photo or CD Video of the entire Puppy you are trying to register.
  
  
• If you must use the US mail, please print and send your COMPLETED registration form along with a cashiers check or money order to the address above. Personal checks WILL NOT be accepted. Any incomplete registration forms or personal checks will be returned without processing.
  
  
• In order to register a Puppy we need Sire and Dam must be registered with the O.R.E.B.A. The Sire, Dam, and photo or CD Video can all be registered at the same time provided that all guidelines are met. The Tail should be long and not cut or Screwed this go for Working Bulldogs. Bandogs or Bandogge can be cut but not Screwed.
  
  
• Voting will determine if the dogs fit the breedings standards.