Assessment Form

Registration Form

Form for the membership registration

"*" indicates required fields

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Our members commit to our member codes, policies and rules and agree to always have a primary focus on the best health and welfare of their dogs. Only those who genuinely see this as a definite commitment to focusing on what is best for dogs should apply.

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User ID

Membership type you’re applying for:

THIS IS NOT A BREEDER MEMBERSHIP

MDBA Associate membership is open to all dog owners over 18 years of age regardless of the type or breed of dog they own. It is perfect for responsible dog owners who want to participate in MDBA events and have access to a wide range of resources.

MDBA Breeder membership is open to anyone over 18 who breeds or intends to breed pedigreed purebred dogs or is working towards breed recognition

MDBA Breeder membership is open to any two people who reside at the same address, are both over 18, and breed or intend to breed pedigreed purebred dogs or are working towards breed recognition.

Membership Term

First Name*

Last Name*

Email Address*

Phone Number*

Address

Street Address City State / Province / Region ZIP / Postal Code Country

State Government number (ie. source or bin, if applicable)

Postal address is different from home address?

Yes

Postal Street Address or PO Box

Postal State

Postal Suburb

Postal Postcode

Postal Country

Shire or Council area

Name of MDBA breeder

MDBA Breeders Prefix

Dog’s name as shown on their pedigree

Dog’s MDBA registration number

Current Canine organisation

Current Prefix (if you have a prefix with another registry)

Yes, I have a prefix from another registry

No, I don't have a prefix from another registry

Prefix if you have one from another registry*

Prefix Application

Prefix Guide

✖

A kennel prefix name must:

Be at least five letters, and must NOT be more than 18 letters, including spaces

Consist of letters only. No symbols, brackets, numbers, apostrophes etc will be allowed

Must not incorporate the name or nickname of an established breed, a breed in development or a crossbreed. (Such as oodle, doodle etc.) or any name the Board deems offensive or inappropriate.

Here is a link to a page that may help you make your choices: Link to Prefix Hints page

Option 1*

Option 2*

Option 3*

Option 4*

Option 5*

Option 6*

Number of dog breeds on your property including cross-breed and desexed dogs*

Breed #1*

Breed #2*

Breed #3*

Breed #4*

Breed #5*

Breed #6*

Breed #7*

Breed #8*

Breed #9*

Breed #10*

Number of dogs over 12 months old on your property that CANNOT be registered with the MDBA

Total number of dogs over 12 months on your property

Total number of fertile females on your property

Partner First Name

Partner Last Name

Partner Phone Number

Partner Email Address

Partner Prefix if you have one from another registry

Have you bred a litter before?

Yes

Reference from puppy buyer 1

Puppy buyer 1 Name

Puppy buyer 1 Email Address

Puppy buyer 1 Phone Number

Reference from puppy buyer 2

Puppy buyer 2 Name

Puppy buyer 2 Email Address

Puppy buyer 2 Phone Number

How did you hear about the MDBA?

Other

Master Dog Breeders and Associates (MDBA)

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