Register Now!

Fill out and print this form and send it with your payment to: Identichip 4894 Lone mountian road PMB 169, Las Vegas, NV 89130.

If you have Microsoft Word you can download the registration form.

To change your information, fill in any fields that have changed, then print.

Animal Information

Microchip Number:

Call Name: Registered Name:

Species: Breed: Sex:

Color: Tattoo/Markings:

Date of Birth: Spay/Neutered: Yes No

Medical Illnesses: Medications:

Allergies: Insurance:

Adoption #: OFA:

Registration Numbers (AKC,CKC,etc.):

License: Cerf:

Rabies: Red Tag #:

Veterinarian: Vet Telephone:

Owner Information

Name: Social Sec. #:

Address: Email:

City: State/prov:

Zip Code: Phone:

work/business phone:

Implant Center Information

Name:

Address: Telephone:

City: State/prov:

Zip Code:

Registration option:

Use your Checking account or credit card securely using PayPal:

Remember: All proceeds from registrations will be donated to shelters in the path of Katrina from September 1st through December 31st. If you don't have animals to register, you can still make a donation by clicking the button below

Click Below for a $10 Standard Registration (please include your full name used on the registration form)

Click below for a $25 Breeder Registration (Please include breeder name used on the registration form)

Click below for a $10 Donation to the Katrina Animal Shelter Fund

Click below to proceed to checkout