APPLICATION FOR AMERICAN BULLY BREED SINGLE REGISTRATION

Please allow 4 to 6 weeks for processing. Please carefully complete this form. UKC® is not responsible for errors caused by illegible handwriting.
Incomplete applications may result in processing delays.

Step 1 Dog Information

Color Sex_______________________ Date of Birth _____________/______________/____________
month day year
Does this dog have a Temporary Listing number? No Yes If yes, TL# _____________________________

Tattoo_____________________________________ Microchip ______________________________________ Is dog spayed/neutered? No Yes. If yes, provide date ________/_________/_______
month day year

Owner/Registrant(s) of Sire at time of breeding (if available) __________________________________________________________________________________________________________________________

Owner/Registrant(s) of Dam at time of breeding (if available) ________________________________________________________________________________________________________________________

Dog Name A dog’s name cannot be changed once it has registered offspring with UKC ®
or attained a UKC® title. Do not use over 30 characters and spaces. Dog’s name must consist of two words or more.
The Sole Signatory’s Last Name will be added to names containing only one word. Any punctuation is considered a space.
UKC reserves the right to deny any name, for any reason. Any name deemed discriminatory or derogatory towards race, religion, gender, sexual orientation, disability, or national origin will be denied.

Step 2 Sole Signatory Information Must be filled out by the Sole Signatory of this dog. If more than one individual is being listed on the dog’s record, the Sole Signatory Designation
Form must be completed. This form can be downloaded at www.ukcdogs.com or requested by emailing [email protected]

Print Name of Sole Signatory ____________________________________________________________________________________________________________________________________________

(If more than one individual is being listed on the dog’s record, the Sole Signatory Designation Form must be completed)

By signing this application I agree to abide by all UKC rules, regulations, and policies; also understand that I am responsible for all information contained herein. All applications and photos become the property of UKC® and are not returned. UKC®
®

reserves the right to refuse an application as well as correct or revoke any registration at any time.
I further attest that the dog for which Single Registration is being applied: a) meets the UKC breed standard, as interpreted by UKC, for the breed for which it is being registered; b) does not exhibit any of the breed standard disqualifications; and
c) is a good specimen of that breed. I give permission to United Kennel Club to use photographs of my dog in all forms of media, and promotional purposes, including but not limited to, publicity, display, advertising, education and editorial use.

Signature of Sole Signatory (Required) ______________________________________________________________________________________________________________________________

Current Mailing Address ________________________________________________________________________________________________________________________________________________

(United Kennel Club is not responsible for undeliverable mail due to incomplete mailing addresses.)

City____________________________________________________________State/ Province ____________________________________Postal Code_________________ Country _________________

Phone ( ______________ ) ________________________________________________________ Email Address ________________________________________________________________________

RULES AND INFORMATION GOVERNING AMERICAN BULLY BREED SINGLE REGISTRATION

*NOTICE* Dogs with known disqualifications will not be registered (see the UKC Breed Standard at www.ukcdogs.com for a list of disqualifications). To be considered for registration with United Kennel Club as an American Bully, simply complete
this American Bully Breed Single Registration Application and forward it to UKC with the following:

Dog must be at least six months of age to submit application for consideration.
Three color photographs of the dog. One of each side and one from the front. All photos should be taken at the dog’s

A copy of the Proof of Registration if available. Please do not send the originals. level, with the dog in a standing position and the tail clearly visible.

A three generation pedigree, if available, either handwritten or an attached photocopy. Please be sure that the handwriting is
Any dog with a docked or surgically altered tail must provide a signed statement from a
legible and that photocopies are of sufficient quality and size for reviewing. Please do not send originals. veterinarian indicating the reason for the altered tail.

If more than one owner is being listed on the dog’s record, a completed Sole Signatory Designation form is also
Continue to Steps 3-4g
required.
 Step 3 Pedigree Pedigree: Forward a copy of your official/certified pedigree or indicate your dog’s 3 generation pedigree below. Please be sure that handwriting is legible and photocopies are of sufficient quality and size for review-
ing. Include any UKC Registration Numbers, if applicable; but do not include titles or degrees. For non UKC registered dogs, the pedigree will appear exactly as it is provided below. UKC is not responsible for information that is not pro-
vided. Information not provided will be indicated as “Not Provided” on the pedigree.

Great Grandsire ________________________________________________________UKC No. __________________

Grandsire ________________________________________________________________UKC No. ______________________
Great Granddam ______________________________________________________UKC No. __________________
Sire __________________________________________________________________________UKC No. (if available) _______________
Great Grandsire ________________________________________________________UKC No. __________________
Granddam ________________________________________________________________UKC No. ______________________
Great Granddam ______________________________________________________UKC No. __________________

Great Grandsire ________________________________________________________UKC No. __________________

Grandsire ________________________________________________________________UKC No. ______________________
Great Granddam ______________________________________________________UKC No. __________________
Dam ________________________________________________________________________UKC No. (if available) _______________
Great Grandsire ________________________________________________________UKC No. __________________
Granddam ________________________________________________________________UKC No. ______________________
Great Granddam ______________________________________________________UKC No. __________________

Step 4 Fees Pricing includes a $15 Non-Refundable

Application Fee.
Credit Card Information (Major Credit Cards Accepted) UKC Office Use Only

Cardholder’s Name __________________________________________________________________
Declined
Approved

1-3 dogs ....................................................................$50 each ______

4-8 dogs ....................................................................$40 each ______ Auth # __________________________________

9 or more dogs ..........................................................$30 each ______ Cardholder’s Signature ______________________________________________________________
(To the same Sole Signatory) In Date_________________ Fee ________
Accelerated Shipping Options are available upon approval of application, Cardholder’s Address ________________________________________________________________
which may take 4-6 weeks. Check No. _________
*
Next Day Air Service ........................................................................$60
(Available for physical mailing addresses in Continental US only / Saturday delivery is not available /
City/State/Province/Postal Code ______________________________________________________ Init ________Ctrl # ________________________
No P.O. Box addresses.)
Single approved ____________________________
*
Expedited Service ............................................................................$40 Credit Card Number ____________________________________________ Exp Date____________
(Upon receipt at UKC, processed and returned within five business days, with tracking number.
Valid email address must be provided. Available in Continental US only.) Checks and money orders must be payable in US funds and made to the order of:
*
Rush Service ..................................................................................$30
(Processed within five business days of receipt at UKC/ does not include time in transit.)
United Kennel Club • Attn: UKC AB Single Reg Dept • 100 E. Kilgore Rd. • Kalamazoo, MI 49002-5584
GRAND TOTAL $ __________ Phone: (269) 343-9020 • Fax: (269) 343-7037 • www.ukcdogs.com • Email inquiries to [email protected]
Accelerated Shipping Options are available upon approval of application, which may take 4-6 weeks. When requesting an accelerated service, write NEXT DAY AIR, EXPEDITED or RUSH on the outside front of the
envelope. Faxed or emailed applications within the continental US will be charged an EXPEDITED Service Fee of $40. Applications outside the Continental US will be charged a RUSH service fee of $30. FO102ADM- Rev. 4-2017