Registration Privilege Application

Harlequin Pinscher Association
Registration Privilege Application

P.O. Box 360
​Fouke, Arkansas 71837
$25.00 annual dues (*$10.00 per additional household applicant)

Name:_________________________________________________

Address: ____________________________________________________________________


City/State/Zip: ______________________________________________________________


Phone #: _____________________________________________Breeder #:_____________


Email Address: ______________________________________________________________


Kennel Name: ____________________________________________________________________


List any other dog registry you are currently using: _____________________________


Are you now or have ever been suspended/banned from another registry? _______
If so which registry:____________________________ dates:_______________________________________________________________________________

I would like to be placed on the breeders list on the HPA website?_______________
I hereby apply for Registration Privileges into the HPA for the 2018-19 Calendar year.
I have read, understand and agree to abide by the Code of Ethics, Standards of Procedures, Policies and Terms of Registration.   I am aware my Registration Privileges may be terminated at any time for just cause.
I do hereby consent to a background check.    I understand my privileges will be terminated and all of my registered Harlies HPA papers will be pulled if I register Harlies with any other registry other than ACR/HPA/APR after the date of this application.
I attest I have never been convicted of animal abuse or neglect.


Signature: ____________________________________________________date:__________

List Additional Household Applicants - $10.00 each annually