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Welcome to the start of the MDBA Victorian Breeder Member Application process.
Please fill out this form and submit it.  There are several pages.
When filling out the application form below please fill out as much detail as you can.
The MDBA will contact you if we need more information so please make sure your contact details are accurate.
Please be assured that all information supplied to the MDBA is treated as confidential.

You can find our fees here http://mdba.net.au/membership/our-fees.html

First Name* VICTORIAN BREEDER MEMBER APPLICATION Applicant Details Last Name* Street Address* Suburb* State* Post Code* Phone 1 * Phone 2 Email* Current Canine Organisation

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

Partner Details if applying for Dual Membership
(Partner must reside at the same address)

Email First Name Last Name Phone 1 Phone 2 Membership Type:* Membership Term:* 1 * 2 * 3 * 4 * 5 * 6 *

Date of Birth*
(Must be in DD/MM/YYYY format)

Shire or Council area* Country*

Date of Birth
(Must be in DD/MM/YYYY format)

Postal Address (if different from residential address) Postal Address Suburb State Post Code Shire or Council area Country

State Government
Source Number

Website Social Media

Details of ALL dogs on your property regardless of whether

you will be registering them with the MDBA or breeding with them

Total number of dogs
on your property
Toatal number of fertile females which
are over 12 months of age
Breeds of dogs you will be registering
with the MDBA
Other breeds of dogs on
your property

Prefix Application (Information about prefix's here)

If you are a new breeder, or in case your current prefix is unavailable, you must give us at least 6 preferences for a kennel prefix, so that we can do searches for availability and approve on for you to use. *

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