International Roman Utility Molosser Registry
Registration Application

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name of dog, 30 characters are allowed, use one space per letter including spaces & punctuation.

Breed: Roman Utility Molosser Color:____________ Coat:________ Sex: M/F Birthday:____________

Tattoo#__________ Microchip#___________ DNA#__________

Height:__________ Weight:__________

(enclose a copy of acceptable registration, 3 generation pedigree, & 4 photos one of the left & right side, front & back of the dog)

Sire: _____________________________ Sire IRUMR # __________ Other Reg # __________

Dam: ______________________________ Dam IRUMR # ___________ Other Reg # __________

Breeder information

Breeder's Name:____________________ Breeder's Signature:____________________ Breeder Number: __________

Address: _____________________________________________________

City:______________________ State: ______ Zip Code: __________ Phone Number: _______________

Veterinarian's Information

The veterinarian signing and filling this section out agrees that the dog in question is a pure rottweiler and has measured the height at the shoulder and weighed the dog.

Height:__________ Weight:__________

Name:____________________ Signature:____________________ Lic. Number: __________

Animal Clinic: _______________________________________________

Address: _____________________________________________________

City:______________________ State: ______ Zip Code: __________

Phone Number: _______________

New Owner Information

Name:____________________ Signature:____________________ Club Member Number: __________

Address: _____________________________________________________

City:______________________ State: ______ Zip Code: __________ Phone Number: _______________

Co-Owner Information

Name:____________________ Signature:____________________ Club Member Number: __________

Address: _____________________________________________________

City:______________________ State: ______ Zip Code: __________ Phone Number: _______________

Service Selections

__$10.00 Standard Registration
__$25.00 Standard Registration with Pedigree

Payment information
Make Payments payable to IRUMR
_____Check or _____Money Order
Send Payments to
IRUMR
13090 N. Ralston Rd.
Maricopa, AZ 85239