U.P.H.A 

Horse's Name:    ________________________________________                
Breed:                 ________________________________________                
Foaled:               _______/________/_______                                                   
                             Month       Day         Year

Stallion
Gelding
Mare

Color or Marking: ________________________________________
Owner:                 ________________________________________
Address:               __________________________________________________________
                             Street                         Town                        State                    Zip Code

U.P.H.A Number: _____________              Date Registered:________________