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2. 
4. Owner Information
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
18. Dog Information
20. Name
21. Breed
23. Color
24. Age
26. Spayed/Neutered?
27. Microchip #
29. Rabies Tag # and Expiration Date

31. Payment is due at time of registration (cash or local check only)

    • Spayed/Neutered Dog $12.50
    • Unaltered Dog $22.50
    • Dangerous Dog $22.50

    *Please bring most current Rabies Certificate with you and ensure certificate includes rabies tag number

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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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