Print Name of Sole Signatory ________________________________________________________________________________________________________________________________________________

Current Mailing Address ____________________________________________________________________________________________________________________________________________________

City ___________________________________________________ State/Province______________________________________________ Postal Code ____________________ Country _________________

Phone (__________ )_____________________________________ Email Address (required for EXPEDITED SERVICE) _________________________________________________________________________By signing this application I agree to abide by all UKC rules, regulations, and policies; including the UKC Breeder Code of Ethics and the Rules and Information Governing Coonhound Single Registration. Additionally, I attest that all of the informa-tion and facts included on this form are true and correct. I further attest that the dog for which Single Registration is being applied: a) meets the UKC breed standard, as interpreted by UKC, for the breed for which it is being registered; b) does notexhibit any of the breed standard disqualifications; and c) is a good specimen of that breed. By signing this application, I understand and agree that any photographs I submit become the property of the United Kennel Club and will not be returned.I give permission to United Kennel Club to use photographs of my dog in all forms of media, and promotional purposes including, but not limitted to, publicity, display, advertising, education and editorial use.

Signature of Sole Signatory (Required) __________________________________________________________________________________________________________________

Sole Signatory Information

Color Sex ____________________ Date of Birth __________/___________/_________

Tattoo_____________________________________ Microchip ______________________________________ Is dog spayed/neutered? � No � Yes. If yes, provide date ________/_________/_______

Owner/Registrant(s) of Sire at time of breeding (if available)__________________________________________________________________________________________________________________________

Owner/Registrant(s) of Dam at time of breeding (if available) ________________________________________________________________________________________________________________________

COONHOUND SINGLE REGISTRATION APPLICATIONApplications are furnished free of charge and can be photocopied as needed. Once submitted, all applications become property of UKC and are notreturned. UKC reserves the right to refuse an application as well as correct or revoke any registration at any time. UKC reserves the right to change anyand all rules, fees, etc. without notice.

Prices effective December 15, 2014

Dog Name Dog name must not exceed 30 characters and spaces. Any punctuation is considered a space. Dog’s name must consist of two words or more. The Sole Signatory’s last name will be added to names containing only one word.United Kennel Club reserves the right to change or deny any name UKC deems to be inappropriate, lewd or offensive.

Step 2 Must be filled out by the Sole Signatory of this dog. If more than one individual is being listed on the dog’s record, the Sole SignatoryForm must be completed. This form can be downloaded at www.ukcdogs.com or requested by emailing registration@ukcdogs.com.

month day year

month day year

To be considered for UKC Coonhound Single Registration as a recognized breed, the dog must meet the crite-ria from one of the following two registration options.1) For a dog of known pedigree from a UKC acknowledged registry.

• Proof of registration from a UKC acknowledged registry. Acknowledged Registries for all coonhound breedsinclude: PKC, AKC. We also accept ALCBA for American Leopard Hounds.

• Dog must have a complete three generation pedigree, either handwritten on this application or as an attached photocopy. • A completed and signed UKC Coonhound Single Registration Application.• Registration fee. (See Step 4.)• Three color photos of the dog must be provided. One of each side, and one from the front. All photos shouldbe taken at the dog’s level, with the dog in a standing position.

2) For a dog that was produced by breeding two UKC Registered Coonhounds (Sire and Dam) of the same breedwho was not litter registered.

• If the dog is less than one year of age, a signed statement from the owner of the Dam (at time of breeding asrecorded by UKC) stating that this litter will not be registered AND granting permission to Single Register thisdog must be provided.

• A completed and signed UKC Coonhound Single Registration Application.• Registration fee. (See Step 4.)• The UKC number and the registered name of both the sire and dam (as listed on the UKC RegistrationCertificate) must be provided in Step 3 “Pedigree”.

• Three color photos of the dog must be provided. One of each side, and one from the front. All photos shouldbe taken at the dog’s level, with the dog in a standing position.

To be considered for UKC X-Bred Coonhound Single Registration, the dog must meet the criteria in the following registration option.3) For a dog of unknown pedigree (dog must appear to be coonhound type), or a dog with a disqualifying color for all

other UKC recognized coonhound breeds, or a dog that is the result of breeding two different UKC recognized coonhound breeds. Dogs registered from this option will be listed as an X-Bred Coonhound.

• A completed and signed UKC Coonhound Single Registration Application.• Registration fee. (See Step 4.)• Three color photos of the dog must be provided. One of each side, and one from the front. All photos shouldbe taken at the dog’s level, with the dog in a standing position.

Dog Information Please check one of the following options.Step 1

NOTE: When requesting an accelerated service, write RUSH,EXPEDITED or NEXT DAY AIR on the outside front of the envelope.Faxed or emailed applications will be charged an EXPEDITED ServiceFee of $35. Incomplete applications may result in processing delays.No refunds will be issued due to an incomplete application.(Only applicable to registration paperwork, excludes product delivery.)

Continue to Steps 3 and 4g

IMPORTANT INFORMATION AND RULES GOVERNING COONHOUND SINGLE REGISTRATION

� American Black & Tan Coonhound� American Leopard Hound

� Bluetick Coonhound� English Coonhound

� Plott Hound� Redbone Coonhound

� Treeing Walker Coonhound� X-Bred Coonhound

PLEASE WRITE CLEARLY. UKC IS NOT RESPONSIBLE FOR ERRORS CAUSED BY ILLEGIBLE HANDWRITING. (Incomplete applications may result in processing delays.)

(Only one individual may be listed as the Sole Signatory.)

(UKC is NOT responsible for undeliverable mail due to incomplete mailing addresses.)

Please allow 4-6 weeks for processing

Sire ________________________________________________________________UKC No. __________________

Sire ____________________________________________________________________UKC No. ______________________

Dam ________________________________________________________________UKC No. __________________

Sire ____________________________________________________________________UKC No. (when applicable) _______________

Sire ________________________________________________________________UKC No. __________________

Dam ____________________________________________________________________UKC No. ______________________

Dam ________________________________________________________________UKC No. __________________

Sire ________________________________________________________________UKC No. __________________

Sire ____________________________________________________________________UKC No. ______________________

Dam ________________________________________________________________UKC No. __________________

Dam ____________________________________________________________________UKC No. (when applicable) _______________

Sire ________________________________________________________________UKC No. __________________

Dam ____________________________________________________________________UKC No. ______________________

Dam ________________________________________________________________UKC No. __________________

Checks and money orders must be payable in US funds and made to the order of: United Kennel Club • Attn: UKC Single Reg Dept• 100 E. Kilgore Rd. • Kalamazoo, MI 49002-5584

Phone: (269) 343-9020 • Fax: (269) 343-7037 • www.ukcdogs.comFaxed or emailed applications within the Continental US will be charged an EXPEDITED Service Fee of $35.

Applications outside the Continental US will be charged a Rush Service fee of $25.

� Registration of dog ................................................................$35

� Next Day Air Service ..........................................................................$50(Available for physical mailing addresses in Continental U.S. only / Saturday delivery is not availableNo P.O. Box addresses.)

� Expedited Service ..............................................................................$35(Available in Continental U.S. only. Upon receipt at UKC, processed and returned within five business days, with tracking number. Valid email address must be provided.)

� Rush Service ....................................................................................$25(Processed within five business days of receipt at UKC / does not include time in transit.)

GRAND TOTAL $ __________

Credit Card Information (Major Credit Cards Accepted)

Cardholder’s Name ____________________________________________________

Cardholder’s Signature__________________________________________________

Cardholder’s Address __________________________________________________

Credit Card Number ____________________________________________________

Expiration Date ________________________________________________________

UKC Office Use Only � Declined � Approved

Auth # ______________________________________________

In Date_________________ Fee ________ Check No. _________

Init _________________________Ctrl # ___________________

Single approved________________________________________

Step 3

Step 4 Fees (Subject to change without notice)

Pedigree You may handwrite your dog’s complete three generation pedigree below or attach a photocopy. Please include any UKC numbers as the pedigree will appearexactly as it is written below. Do not include titles or degrees. Please be sure that handwriting is legible and photocopies are of sufficient quality and size for reading.

Dogs of unknown pedigree will be registered as an X-Bred Coonhound.

NOTE: UKC is NOT responsible for undeIiverable mail due to incomplete mailing addresses.

PHOTOS OF DOG REQUIRED (SEE IMPORTANT INFORMATION AND RULES GOVERNING SINGLE REGISTRATION ON THE FRONT OF THIS APPLICATION) FO42ADM Coonhound Single / Rev. 4-16