Registration Form Form for the membership registration "*" indicates required fields Step 1 of 3 33% Our members commit to our member codes, policies and rules and agree to always have a primary focus on the best health and welfare of their dogs. Only those who genuinely see this as a definite commitment to focusing on what is best for dogs should apply. Membership type you’re applying for:AssociateBreeder DualBreeder Single MDBA Associate membership is open to all dog owners over 18 years of age regardless of the type or breed of dog they own. It is perfect for responsible dog owners who want to participate in MDBA events and have access to a wide range of resources. MDBA Breeder membership is open to anyone over 18 who breeds or intends to breed pedigreed purebred dogs or is working towards breed recognition MDBA Breeder membership is open to any two people who reside at the same address, are both over 18, and breed or intend to breed pedigreed purebred dogs or are working towards breed recognition. Membership Term1 Year3 Years5 YearsFirst Name*Last Name*Email Address* Phone NumberAddress Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands State Government source number (if applicable)Postal address is different from home address? Yes No Postal Street Address or PO BoxPostal StatePostal SuburbPostal PostcodePostal CountryShire or Council area Name of MDBA breederMDBA Breeders PrefixDog’s name as shown on their pedigreeDog’s MDBA registration numberCurrent Canine organisationDo you have a prefix from another registry? Yes, I have a prefix from another registry No, I don’t have a prefix from another registry Prefix if you have one from another registryPrefix Application Prefix Guide ✖ A kennel prefix name must: Be at least five letters, and must NOT be more than 18 letters, including spaces Consist of letters only. No symbols, brackets, numbers, apostrophes etc will be allowed Must not incorporate the name or nickname of an established breed, a breed in development or a crossbreed. (Such as oodle, doodle etc.) or any name the Board deems offensive or inappropriate. Here is a link to a page that may help you make your choices: Link to Prefix Hints page Option 1Option 2Option 3Option 4Option 5Option 6Number of dog breeds on your property including cross-breed and desexed dogs12345678910—Breed #1Breed #2Breed #3Breed #4Breed #5Breed #6Breed #7Breed #8Breed #9Breed #10Number of dogs over 12 months old on your property that CANNOT be registered with the MDBATotal number of dogs over 12 months on your propertyTotal number of fertile females on your propertyPartner First NamePartner Last NamePartner Phone NumberPartner Email AddressPartner Prefix if you have one from another registryHave you bred a litter before? Yes No Reference from puppy buyer 1 Puppy buyer 1 NamePuppy buyer 1 Email AddressPuppy buyer 1 Phone NumberReference from puppy buyer 2 Puppy buyer 2 NamePuppy buyer 2 Email AddressPuppy buyer 2 Phone NumberHow did you hear about the MDBA?Pick from the dropdownMy breederFrom another dog owner/breederLooking for a puppy and saw MDBA breeder’s advertisementFrom doing a website searchOtherOther How did you hear about the MDBA?Pick from the dropdownMy breederFrom another dog owner/breederLooking for a puppy and saw MDBA breeder’s advertisementFrom doing a website searchOtherOtherTell us a bit about yourself and your dogs Learn more ✖ Please tell us about the following: – Your breeding goals; – Breeding aspirations; – Dreams for your dogs; – The breeding problems you have faced; – Areas of weakness, in your knowledge or experience that you want to strengthen; – Your areas of strength; – Your breeding history; – Your greatest breeding disappointments and; – Your greatest breeding achievements; The MDBA needs the above information to process your application. If we do not have enough information it will delay your application progress. Breeding HistoryExpectations you have from your MDBA membership I want to register my dog/s and puppies I want to attend events I want support from like minded people I want to be kept up to date with my legal obligations I want to learn more about dogs I want to learn more about breeding dogs I want to show potential puppy buyers that I am a good breeder Other Other ExpectationsStatement: To be approved to be a Victorian MDBA Breeder member, you must complete the MDBA induction course for Victorian breeders and agree to the declaration below. If you are unsure about your legal obligations for being a dog breeder in Victoria please contact the MDBA 0269276707 or email [email protected] Declaration: I/We understand and agree to the requirements of being a member of a Victorian Applicable Organisation including the requirement of the MDBA reporting on compliance measures in order to keep AO’s self-regulatory status. As an AO the MDBA is expected to ensure members meet high standards for the breeding and keeping of domestic animals, in exchange for the important exemptions for members. I/We have not been found guilty of an offence under the Domestic Animals Act 1994, the Domestic Animals Regulations 2015, the Prevention of Cruelty to Animals Act 1986 or regulations made under that Act, or corresponding offences of another State or Territory law. I/we have read and agree to abide by the MDBA Code of Ethics for Victorian Breeders Link I/we have read and agree to abide by the MDBA Code of Practice for Victorian Breeders I/we have read and agree to abide by the MDBA Rules Link I/we have read and agree to abide by the MDBA Requirements for the advertising and sales of dogs in Victoria Link I/We understand that if we have more than 10 fertile females I/we must have ministerial approval and min standards I/we must follow is the Code of Practice for Breeding and Rearing Establishments. Link I/We understand the legal obligations as a dog breeder in the state of Victoria. I/We will maintain full compliance with these codes and Rules and will maintain no more than the approved number of relevant fertile females on my property. Information contained in this application is true and correct. Declaration: I/we have read and agree to abide by the ‘Applicable Organisation Membership Conditions’ Link I the applicant declare that: I am over 18 years of age The MDBA has my permission to verify the information I have provided I will uphold the MDBA Code of Ethics and will abide by the MDBA rules and policies I have never been found guilty of any animal cruelty or welfare offences and I am not currently under investigation for any animal cruelty or welfare offences. I the applicant declare that both myself and my dual member partner reside on the same property Both myself and my dual member partner reside on the same property This field is hidden when viewing the formTech Approval DateCommentsThis field is for validation purposes and should be left unchanged.
