Nrbc Enrollment Form – Fill Out and Use This PDF

*If you do not have the registration papers back from the breed association, you can still enroll. When you receive

the registration papers, fax, e-mail or mail a copy to us and we will send your NRBC Certiicate at that time.

FOALS ENROLLED BY:

	Postmarked by Sept. 15 of birth year		$200
	Postmarked by Dec. 31 of birth year		$250
	During yearling year**		$2,500
	During 2-year-old year**		$7,500
	During 3-year-old year or later**	$10,000

** Payment plans available

IMPORTANT: These deadlines are for the YEAR the foal is born.

For example, if your foal is born in June 2014, in January 2015 he/she is considered a yearling. It DOES NOT coincide with their actual birth date.

NRBC FOAL ENROLLMENT

Foal Name: _____________________________________ o Pending* from AQHA, APHA, etc.

Foaling Date: ___________________ Breed: ____________________ Sex: o Filly o Colt

Sire: ________________________________________ Registration #: ___________________

Dam: _______________________________________ Registration #: ___________________

Is this foal a result of embryo transfer? o Yes o No

OWNER CONTACT:	ALTERNATE CONTACT:
Name: _______________________________	Name: _______________________________
Address: ______________________________	Address: ______________________________
City/State/Zip: __________________________	City/State/Zip: __________________________
Home Phone: ____________________________	Home Phone: ____________________________
Cell Phone: ___________________________	Cell Phone: ___________________________
Fax: ________________________________	Fax: ________________________________
E-mail: _______________________________	E-mail: _______________________________
Website: ______________________________	Website: ______________________________

Send Foal Enrollment and check, money order, Visa or MasterCard1 to:

NRBC • 13181 US Highway 177 • Byars, OK 74831 • PH 580-759-3939 • FAX 580-759-3999

o Check o Money Order o Visa/MasterCard1

Account #: _________________________________________________________________

Exp. Date: _____________________ CVC #: _______________________

Name on Card: ________________________________________________________________

Billing Address: _________________________________________________________________

Signature: ____________________________________________________________________

1Traditional payment methods accepted are cash and check. For your convenience, Visa and MasterCard are also accepted with a 5% convenience fee.