VERIFICATION OF RECEIPT OF SEMEN AND INSEMINATION OF MARE NAPHA FROZEN SEMEN PROGRAM
Name of Mare _______________________________________________________
Mare's NAPHA Registration Number __________________________________ Mare's Color___________________________________________________ Mare's Description ____________________________________________ Recorded Owner(s) of Mare __________________________________________ Mare Owner(s) Veterinarian or AI Technician ________________________ Stallion's Name ____________________________________________________ Stallion's NAPHA Registration Number ______________________________ Method & Dates of Shipment of Semen ________________________________ I hereby certify that on the dates listed I received shipped, frozen semen from the stallion shown. I have used this semen as instructed to inseminate the mare listed above. I have made a thorough examination of this mare to determine that she is the mare registered with the NAPHA under the name and registration number given above. I further certify that I inseminated said mare and only said mare with the semen provided and that I personally discarded any excess, unused semen in the semen container. Dates of Insemination # Straws of Semen Used 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Date _________________________________ Signature of Recorded Owner(s) of Mare _________________________________ Signature of Veterinarian or AI Technician _____________________________ This form must be filed by January 10th of the year following these breedings. The fine for late filing is $50. The resulting foal will not be registered and Mare Owner not allowed to continue to participate in this Test Program until any fine due is paid.
Contact NAPHA at:
3095 Burleson Retta Road
Burleson, Texas 76028
Tel: (817) 447-7574 Fax: (817) 447-2450
e-mail: info@pphrna.org