Maremma Sheepdog Club of America
Debra Powers,  Secretary / Treasurer
6211 Lake Gulch Road 
Castle Rock, CO. 80104
720-733-3618 
Email:  maremmaclub@aol.com
 
Complete form, print and mail it to the address above.  Please enclose check or money order.  Cost is $10.00 U.S. funds for current MSCA members.   You may also submit your litter registration on line below.
 
***PLEASE NOTE that as of 1/1/12, fees for registering dogs and litters differ for nonmembers. Fees for dog and litter registrations remain at $10.00 for members. For nonmembers fees are $20.00 for dog registrations and $25.00 for litter registrations.

Farm Information:

Farm Name:                 
Owner/Breeder Name: 
Street Address:            
City:                             
State/Province:             
Zipcode:                      
Phone:                         
Cell Phone:                  
E Mail Address:           


Parental Lineage information:

Date of mating:         

Name of Dam:         

Dam Registration #  

MSCA Registered? 

Name of Sire:          

Sire registration #    

MSCA Registered?  

Litter Information:

Date of Birth:          

Number of males: 

Number of females:   
 

I certify the above information is true and correct to the best of my knowledge.  Any false or misleading information may lead to the termination of membership rights including reimbursement of any previous membership fees.

Signature of Owner/Breeder:

Owner of Dam:      

Owner of Sire:        

My membership is current as of: 
 

Maremma Sheepdog Club of America
Debra Powers, Secretary/Treasurer
6211 Lake Gulch Road, Castle Rock CO. 80104
 (720)-733-3618