AMERICAN STAFFORDSHIRE
TERRIER CLUB OF WA
BREEDERS DIRECTORY
APPLICATION FORM

         NAME……………………………..
         PREFIX……………………………
         PH #.................................................
         Email………………………………

         Please tick boxes you would like to be included in!
         Breeders Directory                                                      (  )

         Website Link URL……...……………………........…( )

         Stud Dog Registry                                                       (  )
         Dog's Name……………………………………………
         Sire's Name……………………………………………
         Dam's Name…………………………………………...

         Stud Dog Photo                                                            (  )

    All categories listed above are $5.00 per annum. The Breeders Directory will be
    published both on the official club website also in the each issue of the newsletter.
    Please note that by submitting your application form you are agreeing to abide by
    the American Staffordshire Terrier Club of WA's breeders guidelines, which have
    been set in place to ensure that responsible ownership of puppies is first and foremost
    in everyone's minds, and that all our puppies go to loving and secure homes.

    All cheques/money orders to

   American Staffordshire Terrier Club of WA
   14 Hatch court Forrestdale WA 6112

   Signed……………………………….....Date………….