Nonprofit & Tax-exempt
P.O. Box 222, Davis, CA 95617
Phone/Fax (530) 756-6773
Ck. No.
Dog No.

Institute for
Genetic Disease Control
in Animals

Your GDC Client number - or Name and Address

Reg. Name of Dog

GDC Dog Number, if known

KC Regis. Number

I am aware that this information has been placed in the public domain by the dog's owner with the implied and explicit understanding that it will be available, subject to cdertain rules, to breeders, owners, and prospective owners, breed clubs, and researchers who agree to use it in a responsible and ethical manner for the improvement of the breed. I understand this data is for my private use only, and not for publication.

Signature:_________________________ Date:___/____/____

I enclose $10 ____ for the KinReport(TM); = Progeny & Sibling/Half-Sibling printout form the registries on above dog. I enclose ____a four generation pedigree.


Rev. 08/26/00