Registration Application SEE REVERSE SIDE FOR MARKINGS DIAGRAM
FOR OVERNIGHT DELIVERY TO AQHA: 1600 QUARTER HORSE DR, AMARILLO, TX 79104 • MAILING ADDRESS: P.O. BOX 200, AMARILLO, TX 79168
[Link] • ✆ 806-376-4811 • FAX: 806-349-6405 Español ✆ 806-373-2281
FILL IN ALL THAT APPLY
● S pecial handling fee for 3-4 day service is enclosed. This
$40 fee is in addition to the normal registration fee and does not
provide overnight delivery service. If the box is checked, please make
note on the outside of your envelope: RUSH REGISTRATION.
● O VERNIGHT MAIL service of $20 is included. This service is
available for those who have requested special handling above.
This fee is only applicable for service within the United States and
does not include Saturday delivery charges. For those interested in
service outside the United States and/or Saturday services, please
contact our office at 806-376-4811 for the correct fee.
1 GIVE FOUR NAME CHOICES NOT TO EXCEED 20 CHARACTERS AND SPACES. DO NOT USE PUNCTUATION MARKS.
● I DO NOT WANT AQHA TO NAME THIS FOAL. UNLESS THIS BOX IS CHECKED, AQHA WILL SELECT A NAME IF YOUR NAME CHOICES ARE IN USE OR NOT ACCEPTABLE.
2 COLOR (FILL IN ONE)
● Bay ● Bay Roan ● Black ● Blue Roan ● Brown ● Buckskin ● Chestnut ● Cremello ● Dun
● Gray ● Grullo ● Palomino ● Perlino ● Red Dun ● Red Roan ● Sorrel ● White
3 GENDER
● Stallion ● Mare ● Gelding FOR A LOWER FEE REGISTER YOUR FOAL ONLINE AT
[Link]/services
4 DATE FOALED
MONTH DAY YEAR
5 STATE/COUNTRY FOALED
STATE FOALED COUNTRY FOALED (IF NOT IN U.S.)
SIRE SIRE OWNER AT TIME OF BREEDING
NAME REGISTRATION NO. NAME AQHA ID
DAM DAM OWNER AT TIME OF BREEDING
NAME REGISTRATION NO. NAME AQHA ID
As record owner or authorized agent of said owner of the dam at the time this horse was foaled, or at the time of breeding if by embryo transfer, I hereby certify that all information on this registration application is true and correct to the best of my knowledge, and agree that
AQHA may have the privilege to correct and/or cancel the registration certificate for cause under its rules and regulations. If I am the owner of dam at time of breeding and foaling and correctly sign box 7 and/or 8 (breeder’s certificate), but fail to sign box 6, I understand that
my signature on the breeder’s certificate may be used to satisfy the signature requirements for box 6. By submitting this document to AQHA, I hereby agree to be bound by all the terms and conditions of AQHA’s Official Handbook of Rules and Regulations.
6 SIGN HERE
DO NOT PRINT
WRITTEN SIGNATURE OF OWNER/LESSEE OR AUTHORIZED AGENT OF DAM WHEN FOAL WAS RINTED NAME OF OWNER/LESSEE OF DAM WHEN FOAL WAS BORN, OR OWNER OF DAM
P
BORN, OR BY OWNER OF DAM AT TIME OF BREEDING IF BY EMBRYO TRANSFER. AT TIME OF BREEDING IF BY EMBRYO TRANSFER
ADDRESS
AQHA ID
ADDRESS
CITY, STATE PROVINCE, POSTAL CODE
BREEDER’S CERTIFICATE SECTION – Any erasure or alteration in this section will necessitate verification.
This certifies that the above sire and dam were bred on the following dates, including year: TO
MONTH DAY YEAR MONTH DAY YEAR
7 8
SIGN HERE AQHA ID SIGN HERE AQHA ID
DO NOT PRINT SIGNATURE OF OWNER/LESSEE OR AUTHORIZED AGENT OF STALLION AT TIME OF BREEDING DO NOT PRINT SIGNATURE OF OWNER/LESSEE OR AUTHORIZED AGENT OF MARE AT TIME OF BREEDING
9 FILL IN ALL THAT APPLY
● $40 DNA TESTING FEE REQUIRED FOR PARENTAGE VERIFICATION
● Foal produced by embryo transfer . . . . . . . . . . . . Date embryo transferred: ________ / ________ / ________ Number of embryos transferred: ________
● Foal produced by frozen embryo . . . . . . . . . . . . . Date of implantation: ________ / ________ / ________
● Foal conceived by cooled/transported semen
● Foal conceived by using frozen semen
● Parentage verification/DNA test for other reason
● $40 HYPP TEST ● $85 DISEASE PANEL TEST FOR HYPP, GBED, MH, PSSM1 and HERDA ● $105 DISEASE PANEL and DNA TEST
10 MEMBERSHIP AND REGISTRATION FEES
REGISTRATION FEES ● CHECK ● MONEY ORDER IF PAYING BY CREDIT CARD, PLEASE COMPLETE THE FOLLOWING:
Registration fees are based on foaling date and date application is received. AMERICAN EXPRESS MASTERCARD VISA
EXAMPLE: FOALING DATE: FEBRUARY 15 7-MONTH DEADLINE: SEPTEMBER 15
Member Non-Member
Foaling date to 7 months old . . . . . . . . . . . . . $35 . . . . . . . $75 CARD NUMBER
7-12 months after foaling date . . . . . . . . . . . . $65 . . . . . . $105
12-24 months after foaling date . . . . . . . . . . . $155 . . . . . . $195
24-36 months after foaling date . . . . . . . . . . . $305 . . . . . . $345 EXP. DATE (MMYY) DAYTIME PHONE
36-48 months after foaling date . . . . . . . . . . . $405 . . . . . . $445
48 months after foaling date . . . . . . . . . . . . .$505 . . . . . . $545
CARDHOLDER NAME
FILL IN TO ORDER: TOTAL ENCLOSED / DUE
● Sire DNA kit . . . . . . . . . . . $50
● Dam DNA kit . . . . . . . . . . . $50 $_________________________ CARDHOLDER SIGNATURE BILLING ZIP CODE
SUBSCRIBE ONLINE AT [Link]
SUBSCRIBING TO THE JOURNAL WILL KEEP YOU
AQHA MEMBERSHIP FEES UPDATED ON THE AMERICAN QUARTER HORSE INDUSTRY.
Membership may be purchased at time of transaction DO NOT SEND CASH • U.S. FUNDS ONLY
to receive immediate member-only pricing. Dues payments MAY BE deductible by members as ordinary and necessary business expenses; however, contributions or gifts to the American Quarter Horse
FILL IN ONE: Association are not deductible as charitable contributions for federal income tax purposes. However, donations to the American Quarter Horse Foundation ARE tax
deductible to the extent allowed by law. $1 of your annual membership dues is designated for a subscription to America’s Horse, AQHA’s official member publication.
● 12 Month . . . . . $40 ● 3 Year . . . . . $85 ● Life . . . . . $750 Through the payment of a membership fee to AQHA, I acknowledge that membership in AQHA is voluntary and I agree to be bound by all the terms and conditions
of AQHA’s Official Handbook of Rules and Regulations.
forms-16-255 revised aqha registration application 4-18-16
forms-2000-16-295 fillable form aqha registration application 4-18-16
11 BANK OF AMERICA® QUARTER HORSE RACING CHALLENGE 12 AQHA INCENTIVE FUND
● Y ES! Enroll my horse in the multi-million dollar Bank of America® Racing Challege ● Y ES! the sire of this foal is nominated to the AQHA Incentive Fund for the breeding season
Appropriate fees are included. for further information concerning the racing challenge call 877-222-7223 that produced it and I wish to enroll my foal. APPROPRIATE FEES ARE INCLUDED.
NOMINATION FEES: ● Foaling date to the 7 month birthdate . . . . . . . . . . $125
ANY ERASURE OR ALTERATION
●W
EANLING . . . . . . . . . . . . $300 ● TWO-YEAR-OLD . . . . . . . . . $8,000 WILL NECESSITATE VERIFICATION ● After 7 month birthdate to 12 month birthday . . . . . . $200
(through december of foaling year) AND/ Contact us at 806 376-4811 for
● YEARLING . . . . . . . . . . . . $600 ● THREE-YEAR-OLD . . . . . . .$20,000 OR
further information concerning the
● After 12 month birthdate to 18 month birthday . . . . $1,000
By enrolling this horse, I hereby agree to abide by the rules of the Bank of America Quarter Horse Racing Challenge and the AQHA Incentive Fund Program. ● After 18 month birthdate to 24 month birthday . . . . $2,500
general rules of the AQHA.
NOMINATOR (NAME OF OWNER) OF FOAL AQHA ID NOMINATOR (NAME OF OWNER) OF FOAL AQHA ID
13 WRITTEN DESCRIPTION OF MARKINGS LEFT RIGHT
MARKINGS (FILL IN IF APPLICABLE) ● HORSE HAS NO MARKINGS ● HORSE HAS DORSAL STRIPE HORSE COLOR EYE COLOR
H HEAD
LF LEFT FORE LEG
RF RIGHT FORE LEG
LH LEFT HIND LEG
RH RIGHT HIND LEG
COLOR OF OTHER UNUSUAL MARKINGS
MANE & TAIL OR COLOR, INCLUDING WHORLS
SCARS AND BRANDS,
LIST NAME OF BRAND
14 DRAW MARKINGS OR SEND PHOTOGRAPHS
● HORSE HAS NO MARKINGS
PHOTOGRAPHS MARKINGS
Include quality photos of horse’s markings On the diagram below, outline with dark
Physical photos may be sent, or you may solid lines, all white markings of the
provide CD or flash drive. This media will horse, and draw all scars and brands.
not be returned to you.
Right Side View Left Side View
HOCK KNEE KNEE HOCK
ANKLE ANKLE ANKLE ANKLE
PASTERN PASTERN PASTERN PASTERN
DRAW IN
RH LH LF RF EVERY LF RF RH LH
HIND LEGS FORE LEGS WHITE FORE LEGS HIND LEGS
AREA
Rear View Front View
KNEE KNEE
HOCK HOCK
INDICATE
ALL DARK
SPOTS
WITHIN
WHITE
AREAS
ANKLE ANKLE ANKLE ANKLE
PASTERN PASTERN PASTERN PASTERN
LH RH LF RF RF LF RH LH
HIND LEGS FORE LEGS FORE LEGS HIND LEGS
forms-16-255 revised aqha registration application 4-18-16
forms-2000-16-295 fillable form aqha registration application 4-18-16
