Maremma Sheepdog Club of America
Mary Jarvis, Recording Secretary & Treasurer
2862 S. Peterson Road, Poplar, WI 54864
(715) 364-2646 * Email: grovelandfarm@supwi.com

Application to Register a Litter

Complete form, print and mail it (via the postal service) to the address at the top of this page. Enclose check or money order in U.S. funds!
Place Litter Was Born:
Birth Date: # Males Born: # Females Born:
Sire Name:
Registration #(s):
Dam Name:
Registration #(s):
Date of Mating:

Owner of Dam:
Farm Name: MSCA Registered:
Street Address:
Town:
State/Province:
Country: Zip or Country Code:
Phone: Email:

Owner of Sire:
Farm Name: MSCA Registered:
Street Address:
Town:
State/Province:
Country: Zip or Country Code:
Phone: Email:

I hereby certify that the information contained in this application is
true and correct:
Signature of Sire Owner: Date:

Signature of Dam Owner: Date:

Total cost to register Litter is $10.00. in U.S. funds.

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