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 Farm/Ranch Name

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!
Your Name:
Street Address:
Town:
State/Province:
Country: Zip or Country Code:
Phone: Email:

LIST ALL OF THE MAREMMAS YOU OWN

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

Dog's Name:
Birth Date: Sex:
Registration #(s):

FILL THE AMOUNTS YOU OWN OF EACH BELOW

# of Acres:
Sheep: Llamas: Alpacas: Pigs:
Cattle: Angora Goats: Milk Goats:
Pygmy Goats: Boer Goats: Meat Goats:
Ostrich: Emu: Turkeys: Fowl:
Other Animals:

FILL IN CHOICE OF FARM/RANCH NAME BELOW

1st Choice:
2nd Choice:

Total cost to register Farm/Ranch Name is $10.00.
Remember to enclose check or money order in U.S. funds!

Use your browser "Print" button when finished.