Leavitt Bulldog Association© 2005

Application for registration

Dog’s name___________________________________________
Breeder’s name________________________________________

Breeder’s Phone #_____________________________________
Breeder’s E-mail address________________________________

New owner’s name_____________________________________
New owner’s phone #___________________________________

New Owner’s Home address______________________________

New Owner’s E-mail address______________________________

Sex of dog__________ Color of dog________________________
DOB______________

Tail is (check one)
 Pump__ Straight___ Crooked____ Cork Screw___ Bobbed_____

Wry jaw______ (yes/no)

Signature of person submitting application for registration_____________________

By your signature you are stating this application is true and correct to the best of your knowledge

** Include the registration #’s for all dogs in the pedigree that have been LBA registered.**

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Mail To: Leavitt Bulldog Association Registrations

Marie Morris
P.O. Box 343

Centenary, SC 29519