REGISTRATION for PROFESSIONAL BREEDING PROGRAM
KENNEL NAME
CONTACT PERSON
BREEDER/CKC NUMBER
BUSINESS NAME AND MAILING ADDRESS
TEL
EMAIL
WEBSITE
PREFERRED RETAIL STORE
CATEGORY MEMBERSHIP (CHECK APPLICABLE)
KENNEL BREEDER OTHER
YEARS IN BUSINESS
MEMBERSHIP - PLEASE LIST ALL CLUB, BREED CLUBS, ASSOCIATIONS MEMBERSHIPS
1.
2.
PLEASE LIST BREEDS
1.
2.
3.
NUMBER OF DOGS ENROLLED
PRODUCT YOU WILL BE FEEDING (PLEASE CHECK)
ACANA ORIJEN BOTH
WHAT OTHER PRODUCTS ARE YOU FEEDING?
* MANDATORY