Chincoteague Pony Association

Registration Application

Section 1:

Name: Give Three (3) name choices, not to exceed 25 letters and spaces.

* First Choice:

* Second Choice:

* Third Choice:

YES

* By checking this box I authorize C.P.A. to select a name if the above choices are in use or not acceptable.

* COLOR

Other:

* SEX:

Gelding

Mare

Spayed Mare

Stallion

Section 2:

If foal is purchased from the Chincoteague Volunteer Fire Compnay, the part below containing Birth Date, Dam and Sire information will be filled in by the Chincoteague Pony Association, when application is received. If this apllies to you, continue to Section 3 of this application.
If purchased from another source, the follwing information MUST be filled in by the owner of the Dam and Sire and both MUST be registered Chincoteague Ponies with the Chincoteague Pony Association. The Chincoteague Volunteer Fire Company and The Chincoteague Pony Association recognize no other registration as valid for registering the Chincoteague Pony.

Foaling Date mm/dd/yyyy:

Location, City and State:

Sire:

C.P.A. Reg No.(no dash):

Name of Owner of Sire at time of service:

C.P.A. Reg No.(no dash):

Dam:

C.P.A. Reg No.(no dash):

Name of Owner of Dam at time of service:

C.P.A. Reg No.(no dash):

Name of Owner of Dam at foaling:

C.P.A. Reg No.(no dash):

Location, City and State:

Section 3:

I agree

* By checking this box, As record owner of the above described Pony, I hereby certify that all information on this Registration Application is true and correct to my personal knowledge.

Name of Owner of Pony on this Application:

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

All applications must be accompanied by 4 snapshots of Pony. One each... Front, Rear, Left Side, Right Side.

* Picture 1:

* Picture 2:

* Picture 3:

* Picture 4:

You will be contacted for payment method to complete processing of your registration. Certificates will be mailed upon reciept of payment.

Thank You,
The Chincoteague Pony Assoc.

* Indicates Response Required