Futurity Year: 2012 2013

 DCA Futurity Litter Number:  From your litter confirmation If you have it handy.

 Name of Nominated Bitch:

 Whelping Date of Litter:

 Primary Owner's First Name:

 Primary Owner's Last Name:

 Primary Owner's Address:

 Primary Owner's City:

 Primary Owner's State: Primary Owner's Zip: Canadian Postal Code

 Canadian Province:

 Telephone Number: Email:

 ProPlan Membership Number:

 Puppy #1

 AKC Reg. Name: Sex: Male Female

 AKC Reg. Number:

 Co-owners Full Name:

 Puppy #2

 AKC Reg. Name: Sex: Male Female

 AKC Reg. Number:

 Co-owners Full Name:

 Puppy #3

 AKC Reg. Name: Sex: Male Female

 AKC Reg. Number:

 Co-owners Full Name:

 Puppy #4

 AKC Reg. Name: Sex: Male Female

 AKC Reg. Number:

 Co-owners Full Name:

 Puppy #5

 AKC Reg. Name: Sex: Male Female

 AKC Reg. Number:

 Co-owners Full Name: