NAME and ADDRESS of ORGANIZATION:
    
    
    
    

 PHONE:   FAX:
E-MAIL:   WEB SITE:

PRIMARY OFFICER:
                         TITLE:
PRIMARY OFFICER'S E-MAIL:

PRESIDENT'S NAME:
                    ADDRESS:

DATA: (FROM YOUR MOST RECENT YEAR)
               REGISTRATIONS:
                       TRANSFERS:
             ACTIVE MEMBERS:

LEADING STATES IN REGISTRATIONS
                1.
                2.
                3.
                4.
                5.

NAMES AND ADDRESSES OF OFFICIAL BREED PUBLICATIONS:
#1-
      CIRCULATION
#2-
      CIRCULATION
#3-
      CIRCULATION

RETURN TO:

ZANE AKINS, TREASURER
177 PALERMO PLACE
THE VILLAGES, FL 32159-0094
TEL: 352-259-6005    FAX: 352-259-6005 (NOTE: IF YOU FAX YOU MUST CALL FIRST)