Smart Dog Owner Registration "*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formMembership type you’re applying for:Smart Dog OwnerThis field is hidden when viewing the formUser IDMembership Term1 Year3 Years5 Years100First Name*Last Name*Email Address* Phone NumberAddress Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Dog breedAffenpinscherAfghan HoundAiredale TerrierAkitaAkita Inu (Japanese)Alaskan MalamuteAmerican Hairless TerrierAmerican Staffordshire TerrierAnatolian Shepherd DogAustralasian BosdogAustralian BulldogAustralian Cattle DogAustralian CobberdogAustralian KelpieAustralian ShepherdAustralian Silky TerrierAustralian Stumpy Tail Cattle DogAustralian TerrierAzawakhBasenjiBasset Fauve de BretagneBasset HoundBeagleBearded CollieBeauceron (Berger de Beauce)Bedlington TerrierBelgian Shepherd Dog (Groenendael)Belgian Shepherd Dog (Laekenois)Belgian Shepherd Dog (Malinois)Belgian Shepherd Dog (Tervueren)Bergamasco ShepherdBernese Mountain DogBichon FriseBiewer TerrierBlack and Tan CoonhoundBlack Russian TerrierBloodhoundBluetick CoonhoundBoerboelBologneseBorder CollieBorder TerrierBorzoiBoston TerrierBouvier des FlandresBoxerBracco ItalianoBriardBritish BulldogBrittanyBrittany SpanielBull TerrierBull Terrier (Miniature)BullmastiffCairn TerrierCanaan DogCanadian Eskimo DogCane CorsoCaucasian Shepherd DogCavalier King Charles SpanielCentral Asian Shepherd DogCesky TerrierChesapeake Bay RetrieverChihuahuaChihuahua (Long Coat)Chihuahua (Smooth Coat)Chinese Crested DogChow ChowCirneco Dell'EtnaClumber SpanielCocker Spaniel (American)Cocker Spaniel (English)Collie (Rough)Collie (Smooth)Coton de TulearCurly Coated RetrieverDachshund (Miniature Long Haired)Dachshund (Miniature Silky Wire Haired)Dachshund (Miniature Smooth Haired)Dachshund (Miniature Wire Haired)Dachshund (Rabbit Long Haired)Dachshund (Rabbit Smooth Haired)Dachshund (Rabbit Wire Haired)Dachshund (Standard Long Haired)Dachshund (Standard Smooth Haired)Dachshund (Standard Wire Haired)DalmatianDandie Dinmont TerrierDeerhoundDobermannDogue de BordeauxDutch ShepherdEnglish SetterEnglish Springer SpanielEnglish Toy TerrierEnglish Toy Terrier (Black and Tan)Estrela Mountain DogEurasierField SpanielFinnish LapphundFinnish SpitzFlat Coated RetrieverFox Terrier (Smooth)Fox Terrier (Wire)FoxhoundFrench BulldogGerman PinscherGerman Shepherd DogGerman Shepherd Dog (Long Coat)German Shorthaired PointerGerman SpitzGerman Wirehaired PointerGlen of Imaal TerrierGolden RetrieverGordon SetterGrand Basset Griffon VendeenGreat DaneGreater Swiss Mountain DogGreyhoundGriffon BruxelloisGroenendaelHamiltonstovareHarrierHavaneseHungarian VizslaHungarian Vizsla (Wirehaired)Ibizan HoundIcelandic SheepdogIrish Red and White SetterIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundItalian SpinoneJack Russell TerrierJagdterrier (German Hunt Terrier)Japanese ChinJapanese SpitzKangal Shepherd DogKarelian Bear DogKeeshondKerry Blue TerrierKing Charles SpanielKomondorKuvaszLabrador RetrieverLaekenoisLagotto RomagnoloLaizhou HongLakeland TerrierLandseerLarge MunsterlanderLeonbergerLhasa ApsoLowchenMalteseManchester TerrierMaremma SheepdogMastiffMiniature American ShepherdMiniature Fox TerrierMiniature PinscherMixed BreedMurray River RetrieverNeapolitan MastiffNewfoundlandNorfolk TerrierNorwegian BuhundNorwegian ElkhoundNorwich TerrierNova Scotia Duck Tolling RetrieverOld English SheepdogOtterhoundPapillonParson Russell TerrierPekingesePeruvian Hairless dog ( Medium)Peruvian Hairless dog (Large)Peruvian Hairless Dog (Perro Sin Pelo Del Peru)Peruvian Hairless dog (Small)Petit Basset Griffon VendeenPharaoh HoundPointerPolish Lowland SheepdogPomeranianPoodle (Miniature)Poodle (Standard)Poodle (Toy)Portuguese PodengoPortuguese Podengo (Large Smooth)Portuguese Podengo (Large Wire)Portuguese Podengo (Large)Portuguese Podengo (Medium Smooth)Portuguese Podengo (Medium Wire)Portuguese Podengo (Medium)Portuguese Podengo (Small Smooth)Portuguese Podengo (Small Wire)Portuguese Podengo (Small)Portuguese Water DogPrague Ratter (Prazsky Krysarik)PugPuliPumiPyrenean MastiffPyrenean Mountain DogPyrenean Sheepdog (Longhaired)Pyrenean Sheepdog (Smooth Faced)Rhodesian RidgebackRottweilerRussian Toy (Long Haired)Russian Toy (Smooth Haired)SalukiSamoyedSchipperkeSchnauzerSchnauzer (Giant)Schnauzer (Miniature)Scottish TerrierSealyham TerrierShar PeiShetland SheepdogShiba InuShih TzuShikokuSiberian HuskySkye TerrierSloughiSlovak Rough-haired PointerSoft Coated Wheaten TerrierSpanish MastiffSpanish Water DogSt BernardStaffordshire Bull TerrierSussex SpanielSwedish LapphundSwedish VallhundTatra Shepherd DogTenterfield TerrierTheodoreTibetan MastiffTibetan SpanielTibetan TerrierWallace BulldogWeimaraner (Longhaired)Weimaraner (Shorthaired)Welsh Corgi (Cardigan)Welsh Corgi (Pembroke)Welsh Springer SpanielWelsh TerrierWest Highland White TerrierWhippetWhite Swiss Shepherd DogXoloitzcuintleYakutian LaikaYorkshire TerrierName of MDBA breederMDBA Breeders PrefixDog’s name as shown on their pedigreeDog’s MDBA registration numberI the applicant declare that: I am over 18 years of age The MDBA has my permission to verify the information I have provided I will uphold the MDBA Code of Ethics and will abide by the MDBA rules and policies I have never been found guilty of any animal cruelty or welfare offences and I am not currently under investigation for any animal cruelty or welfare offences.