East Coast Quality Breeders Association

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We know there are a lot of questions in this form - there is no right or wrong answer. Please completely answer ALL questions as it helps us to get a better idea of the best way in which we can help you. First Name Last Name Kennel Name (if applicable) Birthday Please Select January February March April May June July August September October November December Please Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: Address City State Please Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SD SC TN TX UT VA VT WA WI WV WY Other Zip Telephone Cell Phone Fax Email Address Website Address Where would you like your listing to appear on our website? Please Select As a breeder under my breeds As a Veterinarian As a service or resource Looking for a puppy Concerned Dog Owner Main breed of dog that you raise # of Females / # of Males Second breed of dog that you raise # of Females / # of Males Third breed of dog that you raise # of Females / # of Males How many litters do you raise in one year? How long have you been raising dogs? How would you rate your level of expertise in breeding dogs? Please Select Interested in Breeding New to Breeding Some Experience Very Experienced How do you usually find new homes for your puppies? Please Select Paid Online Classified Ads AKC Online Classified Ads Free Online Ads Already have prospective homes before pups are born How much do you pay, on average, for advertising each month? Are your dogs registered? Please Select No Yes - with AKC Yes - with CKC Yes - with other organization Do you micro chip your puppies before they leave your premises? Please Select Yes No Do you micro chip your puppies yourself or does your Veterinarian? Please Select I do them myself My veterinarian does it Do you immunize your puppies yourself or does your Veterinarian? Please Select I do them myself My veterinarian does it Have you ever had a kennel inspection? Please Select Yes No If Yes by whom? If Yes when? (MM/YYYY) How are your adult dogs housed? Please Select My dogs are in the house with me My dogs are in outside well maintained kennels My dogs are both inside and outside How are your puppies housed? Please Select My pups are in the house with me My pups are in outside well maintained kennels My pups are both inside and outside Please rate your main reasons from #1 to #4 for joining ECQBA as a member - please use #1 as your main reason Information on legislation Networking with other breeders Education Finding homes for your puppies Are you interested in becoming a voluntary board member for ECQBA? Please Select Yes - Please consider me No Thank You Not able to at this time Are you interested in aiding us to stay on top of current and proposed legislation? Please Select Yes - Please consider me No Thank You Not able to at this time Level of Yearly Membership Required - see descriptions below Please Select Bronze - $35 Silver - $45 Gold - $55 Platinum - $65 How would you like to pay for your membership? Please Select Online by Credit Card I will mail a check Level of memberships available: Bronze Membership - $35 per year: Includes access to the website and forums and the ability to post and answer questions from other members and the public. Includes a listing in the online member directory. Monthly email newsletter with educational information and articles, as well as news from our sponsors. Litter advertisements are available to bronze members at $5 per advertisement. Silver Membership - $45 per year: Includes all Bronze level benefits plus the ability to post three free litter advertisements during a calendar year. Listing in online breeder directory under main breed of dog (we classify your main breed by the number of adult females in your possession. Gold Membership - $55 per year: Includes all Silver level benefits plus listing in online breeder directory for two breeds of dog and six free litter advertisements per calendar year. Platinum Membership - $65 per year: Includes all Gold level benefits plus listing in online breeder directory for up to three breeds and eight free litter advertisements per calendar year.