Single Registration
Name of Dog                                                                                                                                                   

Breed                                                                                                             Sex                                           

Color                                                                            Date of Birth                                                             

Sire                                                                                                                                                                
Color                                                                            Date of Birth                                                              
Registration Number                                                                                                                                      
Owners Name                                                                                                                                                 
Address                                                                                                                                                          
City                                                                              State                                                       Zip              

Dam                                                                                                                                                               
Color                                                                           Date of Birth                                                               
Registration Number                                                                                                                                      
Owners Name                                                                                                                                                 
Address                                                                                                                                                          
City                                                                             State                                                           Zip           

Dogs Owners Name                                                                                                                                        
Address                                                                                                                                                          
City                                                                              State                                                          Zip           
E-Mail Address                                                                                                                                               
Home Phone                                                                  Work Number                                                           
Please include a picture of the dog, a copy of any existing registrations and pedigrees.

              SEND $10.00 US Funds POSTAL MONEY ORDER PAYABLE TO RAY GIACOBBE                            

Ray Giacobbe                                                                                                       WBAregistry@aol.com
1700 Ridgewood Avenue. Suite D                                                                               1-386-437-4762
Holly Hill, Florida. 32117