HALF BREED REGISTRATION
Keep the Chincoteague Pony blood recognized.

REGISTRATION APPLICATION FOR THE NATIONAL CHINCOTEAGUE PONY ASSOCIATION

The NCPA
2595 Jensen Road, Bellingham, Washington 98226-9425
Phone: 360-671-8338  Email: GFreder426@aol.com
SECTION 1: COMPLETE INFORMATION ON EQUINE TO BE REGISTERED
TYPE OR PRINT LEGIBLY - PICTURES TO BE CLEAR & SHARP - CORRECT FEES
Enclose Chincoteague Firemen Vet & Auction Receipts or Original Registration Papers.

First Choice:
EQUINE'S NAME:__________________________________
2nd Name Choice__________________________________

SEX: S____ M____ G____ Filly__ Colt___
Spayed Mare_____.

Pony's Height____ Pony's Weight _____approx.

Blood type (optional)__________________________

DOB: MO___Day___Yr___ (if known) Approx. age _____Location, City and State________________.
Color: Mane__________ Tail___________

BASE COLOR: White__Brown__Roan__Dun__Grey__Black__Grullo__Chestnut__Bay__
       Sorrel__Palomino__Buckskin__Other__

 
PAINT/PINTO PATTERN: Tobiano___Overo___Tovero___Sabino___
COLORS:________________________.         ;          

        BLUE EYES: ___Y ___N - Right Eye___ Left___ Partial___
REMARKS: list any unusual markings, scars, brands, and location:
_________________________________________________________
Was this foal conceived by artificial insemination?______yes_______NO___________


Sire:(name/color,pattern,reg. number)____________________________________________
Unknown, Island Bred_________________________________

Owner of Sire at time of service_______________________.Virginia Park Dept______.
Address:_____________________________________________________________________

Dam: (name/color, pattern and registration number)____________________________________________
_______________________________________.
Unknown Island, Bred______________________.

Owner of Dam at time of service_________________.Virginia Park Dept.________.
Address:_____________________________________________________________________

Owner Of Equine______________________________________Phone___________Company_________
Address_____________________________________________________Email____________
Amt. Enclosed For Reg.:$__________ - Plus Photos (4) U.S. FUNDS - Plus Chincoteague Pony Firemen Vet and or Auction receipts if applicable.
    ($45.00 (if a paid member) - $50.(if membership not wanted)

Please enclose 4 color photos of your pony.  One from each side. 1 to show face & 1 from behind.

Signatures of all joint owners required:
Signed___________________________________Date__________________________

Signed____________________________________Date__________________________

All information is correct to the best of my knowledge and belief as certified by my written signature. Any fraudulent statements herein automatically cancels registration. (This application is accepted with the right to correct and/or revoke.) All persons applying for registration are responsible for knowledge of the current Rules and Regulations governing registration requirements as set forth in the Official NCPA Registration Book. ===================================================================================

OFFICE USE ONLY-DO NOT WRITE IN THIS SPACE

ACCEPTED: __Y __N  DATE RECEIVED:__________   ASSIGNED REG.#________
ASSIGNED  PERSONAL #:______ DISCOUNT APPLIED:__Y __N  AMT. PD:______
NOTES:________________________________________________________________

Please return this form and your remittance to:
The National Chincoteague Pony Association
2595 Jensen Road
Bellingham, WA 98226