BOSTON TERRIER CLUB OF AMERICA INC. 
Futurity - Stud Dog Nomination Form
Please Print Plainly
Futurity Year__2010__________
Date____________________
Name of Stud Dog______________________________ AKC No.
_________________ Date of Birth _________________
Owner or Lessee of Stud______________________ Phone (____)______________
Owner must be a member of the BTCA in good standing at the time of
nomination.
Address__________________________________________________________
Check Attached: $_______________E-Mail Address: _________________________
IMPORTANT NOTICE: All breeding (s) to be acceptable for
Futurity nomination MUST conform to the Code of Ethics set forth by
the BOSTON TERRIER Club of America Inc.
Enclosed $_________ Make checks payable to BTCA [Payable in US
Dollars Only, Cancelled Check Will Be Your Receipt] < BR>
_____________________________________________
Signature
Fee of $25.00 for each Stud Nomination must accompany Nomination Form.
Mail the above form with fee to FUTURITY DIRECTOR:
Ken Roux, 1687 Jaydee Ave. Dixon, IL. 61021, Phone:815-285-3647,
Print THREE Forms:
Copy 1 - will be held by Futurity Director
Copy 2 - will be returned to you marked "Accepted"-provided you send
S.A.S.E.
Copy 3 - will be held by you for your records
NOTE: Stud nomination forms must be postmarked before whelping date.
(see Futurity Stakes Rules)
Ck# ________________ Amt. _______________ Postmarked
___________________
Processed ___________________ Accepted ______________ Rejected
_____________
