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Stud owner to fill out completely, print, sign, and mail to the EJRTCA..........

    This is to certify the Bitch:
    REGISTERED NAME________________________________________________________

    EJRTCA'S REGISTRATION NUMBER: _______________________
    OWNED BY.....
    NAME____________________________________________________________________

    ADDRESS: ________________________________________________________________

    CITY_____________________________________________________________________

    STATE: _____________________ ZIP: _______________COUNTRY: _________________

    Was bred to my Stud Dog:
    REGISTERED
    NAME____________________________________________________________________

    EJRTCA'S REGISTRATION NUMBER: _______________________
    OWNED BY.....
    NAME: ___________________________________________________________________

    ADDRESS:
    _________________________________________________________________________

    CITY: ____________________________________________________________________

    STATE: _____________________  ZIP: _____________COUNTRY: ___________________

    DATE(S) BRED:
    _________________________________________________________________________
    Are either the Sire or Dam Registered with any other organizations? If so, please
    give name of organization and registration number:
    _________________________________________________________________________
    As the owner(s) of the Stud, I (we) hereby certify this information to be true.

    Signed: ____________________________________________Date: _________________

    Signed: ___________________________________________  Date: _________________

    Form ej-stud.html Issued 4/8/97 updated 9/8/99, 7/6/05, 1/1/07

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