Membership Checkout Membership Information You have selected the Dog Registration with Family membership level. Add up to 2 dogs to your family membership The price for membership is $0.00 now. Group Code Account Information Username Password Show Password Confirm Password First Name Last Name Email Address Confirm Email Address Full Name LEAVE THIS BLANK Already have an account? Log in here Dog Information Before Commencing This Section Please look through the questions on the form and ensure you have all of the required information on hand before starting. If you are missing information, please close this form and return when you have all of the required information. This information is used to import your dog's data into the breed register. Incomplete information will create an inaccurate record on the Breed Register and delay the issuing of your Registration certificate. Your Member Number Breeder Prefix / Name Dog's Official Name (Breeder designated Dog's Call Name (Name you gave your dog) Sex Male Female Dogs Date of Birth If unknown go to next field Date of Birth is unknown Yes No Microchip Number This is a 15 digit number Has your dog been neutered? Yes No Dam (Mother's Name) Sire (Father's Name) Dogs Role/Use (Select all appropriate options) Family Pet Working - Flushing and Upland Working - Retrieving Water and Land Working - Other Hunting Dog Trials - Retrieving Trials - Tracking Assistance Dog Other (please specify below) Other Role/Use Eye Colour Weight (kg) if over 2 years Coat Type Long Medium Short Curls Tight Medium Loose Chest Blaze (white markings on chest) None Thumbprint (small) Blaze (a stripe) Full Chest (significant) Has your dog/bitch ever had puppies? Yes No Outcross Curly Coated Retriever Irish Water Spaniel No Outcross Other (please list below) Other Outcross Upload a Photo - Portrait (Under 2 year old) Upload a Photo - Profile (Under 2 year old) Upload Photo - Portrait (Over 2 year old) Upload Photo - Profile (Over 2 year old) Hip Score (if assessed) Elbow Score (if assessed) Has your Dog been DNA tested Yes No Member Acknowledgements and Sign-off All Members must abide by the Club Rules and Regulations. Acknowledgement I understand that my membership application must be approved by the MRRA Committee I understand that the membership is annual and the membership year runs from 1 July to 30 June I acknlowledge the MRR Association Rules and regulations and will abide by them Member Details (Family Extras) Member Type Human Dog Name (single field) Enter full name. We will split into First/Last internally. Membership Number Dog Breed Reg. 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