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Name Of Mare:
Are You The Original
Owner/Breeder Of The Mare
Registered With This Form?
Year Of Birth:
Sire:
Dam:
Currently In Foal To:
Mare Open?
Last Cover Date:
Domicile Of Stallion:
Date Mare Entered
Louisiana Program
Or Transferred Ownership:
Mare Owner:
Address:
City:
State:
Zip:
Home Phone:
Business Phone:
Cell Phone:
Fax:
Email:
Farm Where Mare Is Domiciled In Louisiana:
Contact Person At Farm:
Address Of Farm:
City:
State:
Zip:
Farm Phone Number:
Directions To Farm Where Mare Is Domiciled In Louisiana:
Amount Due:
Payment Method:

Name Of Person Signing:
I agree that I have read and understand the L.T.B.A. Inspection Guidelines And Mare Fees
*****
SEE L.T.B.A BY-LAWS FOR ACCREDITATION OF FOALS