East Coast Quality Breeders Association : Members

We know there are a lot of questions in this form - there are no right or wrong answers. Please completely answer ALL questions as it helps us to get a better idea of the best way in which we can help you. (Required fields are boldface).

Silver Membership Application

Tell us who you are

First Name

Last Name

Your Birth Date (minimum age 16)--

Kennel Name

What type of membership are you applying for?

Referred By
Please enter the name, kennel name or email address of the person that referred you.

Choose a password

Enter a password

Enter again to confirm

Where are you located?

Address 1

Address 2

City

State

Zip

Country

How can we reach you?

URL/Website Address http://

Phone

Cell

Fax

Tell us about yourself and your operation

Breeding Experience Level

How many years have you been raising dogs? (Enter 0 if less than one year; leave blank if not applicable)

When was your last kennel inspection?

Who conducted the inspection?

How do you usually find homes for your dogs?

How much do you pay, on average, for advertising each month ($)?

Do you micro chip your puppies before they leave your premises?

Do you immunize your puppies?

Do you remove dew claws?

How are your adult dogs housed?

How are your puppies housed?

Tell us about your dogs

How many litters do you raise in one year?

Are your dogs registered?

Main breed of dog that you raise

Primary Breed

Breed 1 number of females

Breed 1 number of males

Do you provide stud service for this breed?

Do you have puppies available right now? (You can keep this updated in the breeder listings!)

Please rate your main reasons for joining.

Priority One

Priority Two

Priority Three

Priority Four

Want to help the Quality Breeders Association in a special way?

Are you interested in becoming a voluntary board member?

Are you interested in helping us stay on top of current and proposed legislation?