The stallion must be listed with APHA for breeding and have DNA genetic markers on file prior to the registration of any foals. You may order a DNA genetic test kit below.

Name of Stallion: __________________________________________________________________________________________________________________________

Registration Number:_______________________________________________________ AQHA Number (If Applicable): ____________________________________

Registered Owner: _________________________________________________________ APHA I.D. Number: _____________________________________________

Address: __________________________________________________________________________________________________________________________________

City: ____________________________________________________________ State: ________________________________________ Zip code: _________________

Daytime Phone: _________________________________________________ E-mail: __________________________________________________________________

1. Paint stallion owners should list all mares exposed, whether Paint, Thoroughbred or Quarter Horse. Thoroughbred or Quarter Horse stallions will only report Paint mares.2. If the mare did not conceive using one method and she was rebred to the stallion using some other method, each different exposure should be listed on the report.3. If pasture bred, give the date the mare was turned into the pasture and the date she was taken out of the pasture. Give exact date(s) bred – if more than one service is received by a given mare

using the same method, be sure to list the first and last dates of exposure. (When issuing a Breeder’s Certificate to mare owners, be sure the dates correspond with those reported on this form).4. Specify method of breeding: P = Pasture, H = Hand, A = Artificial Insemination, S = Trans ported Semen, F = Frozen Semen, E = Embryo Transfer5. Release of Breeding: If all mare owner requirements and financial obligations have been met, you can release the breeding by initialing the Release of Breeding column. Your initials will au-

thorize APHA to register the foal without your signature on a Breeder’s Certificate.6. Stallions must have their 6-panel genetic health test results (HYPP, HERDA, GBED, MH, PSSM1 & OLWS) on file before foals born in 2019 and beyond can be registered.

Registered Name of Mare Bred (See 1 and 2 above) Registration Number Recorded Owner of Mare

Breeding Method(4 above)

Date First Exposed (3 above)

Date Last Exposed (3 above)

Release of Breeding

(Initial, 5 above)

1. X

2. X

3. X

4. X

5. X

6. X

7. X

8. X

If paying by credit card, please complete the following.

Card No.: ______________________________________ Exp. date: ______________

CVV#: __________ Name of Cardholder: ____________________________________

APHA I.D. No.: __________________________________________________________

Address: ________________________________________________________________

City: ____________________________________________________________________

State: __________________________ Zip: ___________________________________

Daytime phone: _________________________________________________________

E-mail: _________________________________________________________________

Signature: X ____________________________________________________________

To avoid delays, please be sure to indicate the breeding year in the box above and sign where indicated.

Membership Levels One-Year—$45 Three-Year—$105 Five-Year—$175 Lifetime—$750

Junior One-year—$25 (Age 18 or younger) Birthdate: ____ /_____ /_____

Junior Three-year—$55 (Age 18 or younger) Birthdate: ____ /_____ /_____

J-Term—$125 (Good through age 18) Birthdate: ____ /_____ /____

Total Amount Due

Stallion Listing Fee: $________________

Report Filing Fee: $________________

Per Mare Fee: $________________

Late Fee: $________________

Add a Mare Fee: $________________

DNA Kit Request: $________________

Membership Dues: $________________

TOTAL: $________________

Payment Method Check or Money Order enclosed. Do not send cash Check Processing Policy: In the event that your check is returned unpaid for insufficient or uncollected funds, we may present your check electronically.

MasterCard VISA American Express

Rev. 1/18

Fees* Member Rate

Stallion Listing Fee (one-time fee) $75 Report Filing Fee $10 Per Mare Fee $5 Late Fee (after November 30) $25 Add a Mare Fee $10 DNA Kit Request $60 Genetic Health Panel Kit $125 Color and Pattern Panel Kit $125 OLWS DNA Test $25

(for stallions with 5-panel results on file with APHA or AQHA)

*In order to take advantage of reduced member rates, membership must be held or purchased in the exact name as that which the sire is owned at the time of breeding. Memberships begin in the month in which the report is postmarked. Fees subject to change without notice.

I do certify that the mares listed in the chart above were exposed to this stallion during the CALENDAR YEAR of: _______________

Recorded Owner or Authorized Agent Signature: X ____________________________________________________________________________________

Stallion Breeding Reports must be postmarked by November 30th of the breeding year. Postal Meters not accepted.For stallions standing south of the equator, this report must be filed on or before the 31st of May of the breeding year.

Stallion Breeding Report American Paint Horse AssociationP.O. Box 961023 • Fort Worth, Texas 76161-0023(817) 834-APHA (2742) • Fax: (817) 834-3152apha.com • askapha@apha.com

American Paint Horse AssociationP.O. Box 961023 • Fort Worth, Texas 76161-0023(817) 834-APHA (2742) • Fax: (817) 834-3152apha.com • askapha@apha.com