(shaded areas for office use only) REGISTRATION NUMBER ISSUED___________________________________________________________________

Established & Incorporated 2006	AMERICAN BLAZER HOSE ASSOCIATION, INC. 16114 Idaho Center Blvd, Suite 3 Nampa, ID 83687 (208) 461-1055 www.BlazerHorse.com Email completed form to registrar@blazerhorse.com or mail to the office with payment. APPLICATION FOR REGISTRATION

Horses Information:

Date Foaled: Foaled At: City & State: Click or tap here to enter text.

Gender:	Stallion ☐ Mare ☐ Gelding ☐ Date gelded: Click or tap here to enter text.

Horse’s Body Color:

☐Sorrel	☐Brown	☐Dun	☐Grulla	☒Palomino	☐Bay Roan	☐Blue Roan

☐Chestnut	☐Bay	☐Red Dun	☐Black	☐Buckskin	☐Red Roan

Mane and/or Tail flaxen, silver or white? ☐Yes ☐ No	Eye Color: Click or tap here to enter text.

NAME 1st choice Click or tap here to enter text. 2nd choiceClick or tap here to enter text.

(Names to be no longer than 30 characters, including spaces. For more information on naming your horse see Rules and Regulations).

In order to grant registration, the applicant have at least one linage back to Little Blaze F1, foundation sire and meet conformation and height requirements (at maturity) for the American Blazer Horse Association. All horses registered before 2006 in the Blazer Horse Association will be accepted. Sires or dams not registered with the ABHA should file for a breeding stock number; their pedigree information and description will then be entered into the ABHA “Breeding Stock” record, allowing their pedigree information to be shown on their offspring’s registration certificate. If no stallion report is available, the sire will be listed as “unknown”. A stallion’s breeding report must be on file with the ABHA office or must accompany this application if the sire is to be listed on the applicant’s

Please draw in the markings in as best as you can and send in the required 5 photos, front, back, left, right and top.

Page 2 for NAME 1st choice Click or tap here to enter text. 2nd choiceClick or tap here to enter text.

Sire Information: Sire’s Name: Click or tap here to enter text.

ABHA Reg# Click or tap here to enter text. or ABHA Breeding Stock#: Click or tap here to enter text.

Sire’s Primary Equine Registry and Reg# if not ABHA: Click or tap here to enter text.

Sire’s Registered Owner/Agent: Click or tap here to enter text.

Address and Phone: Click or tap here to enter text.

Dam Information: Dam’s Name: Click or tap here to enter text.

ABHA Reg# or ABHA Breeding Stock#:Click or tap here to enter text.

Dam’s Primary Equine Registry and Reg# if not ABHA:Click or tap here to enter text.

Dam’s Registered Owner/Agent:Click or tap here to enter text.

Address Click or tap here to enter text.Phone:Click or tap here to enter text.

Signature of the Dam’s Owner at time of foaling: Click or tap here to enter text.

By submitting this form, the typed name becomes the electronic signature.

Owner(s) Information: ABHA Membership Number: Click or tap here to enter text.

Owner(s) Name: Click or tap here to enter text.

Address: City, State, Zip: Click or tap here to enter text.

Phone: Click or tap here to enter text.

Email: Click or tap here to enter text.

Signature of owner verifies all information to be true and correct to the best of their knowledge:

Signature: Click or tap here to enter text. Date:Click or tap here to enter text.

If submitting this online, the typed name becomes the electronic signature.

Completed application, photographs, registration fees and membership dues (where applicable) payable in US funds; must be included with application. When applying for membership, please include membership form whenever possible. Email completed form to registrar@blazerhorse.com or mail completed forms to Blazer Horse Association, 16114 Idaho Center Blvd, Suite 3, Nampa, Id 83687
90 days or 1st Calendar Year 1 to 3 years 4 Years and over	Members $25 $100 $200	Non-member $50 $125 $225	ABHA Membership: Annual Membership:…………………………...…...$25 Lifetime Membership …………………………………….....…$225

All forms and other information are available on the American Blazer Horse website at www.blazerhorse.com. You can also make online payment for your items or mail your paperwork and forms to the office. Please include a note, if you do pay on line, include the order number from your receipt.