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Welcome to the start of the MDBA 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* 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) Breed/s

Prefix (if your partner has a prefix with another registry)

Email First Name Last Name Phone 1 Phone 2 References from two puppy buyers (not required for new breeders yet to breed a litter) 1 2 Name Address Phone Membership Type:* Membership Term:*

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. *

1 * 2 * 3 * 4 * 5 * 6 * Shire or Council area* Country* Postal Address Street Address Suburb State Post Code Country

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

Total 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

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