This form must be postmarked                      BULL TERRIER CLUB OF AMERICA, INC
BEFORE litter is born.                                              Futurity Bitch Nomination Form

PLEASE PRINT CLEARLY

Futurity Year___________________________________________________________________
Name of Bitch_________________________________  AKC Reg. No.____________________
Owner or Lessee of Bitch_________________________ Phone (____)_____________________
Address______________________________________________________________________
Date of Breeding__________________________ Estimated Whelping Date__________________
Name of Sire__________________________________  AKC Reg. No.____________________
Owner of Sire__________________________________________________________________
Address______________________________________________________________________

Check Attached: $_____________                                                     Nominator must be the breeder or co-breeder, and
(canceled check will be your receipt)                                                   a member in good standing of the BTCA at both the
                                                                                      date of nomination and futurity judging.
Make checks payaable to BTCA                                                          ______________________________________
                                                                                                                                       
(Signature)

Fee of $20.00 for each Bitch Nomination must accompany Nomination Form.
Mail all three forms with fee to Futurity Secretary, Alison Ibbitson,                               Chk#_____     Amt.______
121 Pennapacker, Trappe, PA  19426                                                                                    Postmarked____________
                                                                                                                                                    Processed_____________
COMPLETE THREE FORMS:                                                                                             Accepted___Rejected____
(one will be held by Futurity Secretary, one will be returned to you
marked "Accepted" and one will be sent to the BTCA Treasurer)
                                                                                                                 
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