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BELGIAN SHEPHERD EPILEPSY REGISTRATION

  

 

FILL IN THE BLANKS. COPY THIS PAGE INTO AN E-MAIL AND SEND TO GULLOEV@MAIL.DK

IT IS VERY IMPORTANT THAT YOU FILL IN ALL THE FIELDS OF THE REGISTRATION
PEDIGREE NAME: 
YEAR AND DATE OF BIRTH:
YEAR AND DATE OF DEATH
SEX:
DATE OF THE NEUTERING/SPAYING
VARIETY:
DATE AND YEAR OF THE FIRST EPILEPTIC FIT                   
HOW OFTEN DO THE FITS COME
DESCRIBE  A TYPICAL FIT
   
   

ALL OF THE BELOW MENTIONED INFORMATION MUST BE GIVEN BUT WILL NOT BE PUBLISHED
I AM THE BREEDER OF THE DOG
I AM THE OWNER OF THE DOG
YOUR NAME:
YOUR ADDRESS:
YOUR E-MAIL:   
YOUR TELEPHONE NO.:
   
   

 I  ACCEPT THAT MY INFORMATION CAN BE USED AND PUBLISHED  

PEDIGREE 

FATHER: GRANDFATHER:  GREAT GRANDFATHER:   
GREAT GRANDMOTHER  
GRANDMOTHER: GREAT GRANDFATHER:
GREAT GRANDMOTHER 
MOTHER: GRANDFATHER:   GREAT GRANDFATHER:
GREAT GRANDMOTHER   
GRANDMOTHER:  GREAT GRANDFATHER: 
GREAT GRANDMOTHER 

IF YOU HAVE PROBLEMS SENDING YOUR INFORMATION - PLEASE CONTACT gulloev@mail.dk