I,
                        Name of Applicant                              Telephone Number                       eMail Address        

                        Street                                                 City                                                 State           Country                Zip

request that the HORSE described below be branded with the ATA purebred brand signifying that the horse is registerable or registered as a purebred Trakehner from approved breeding stock in accordance with the Corporate Regulations of the Association:

        Sex: Stallion Mare Colt Gelding    Registration Pending    Name Applied For:
        Color and markings:
        Foal Date:        Breeding Certificate Submitted: Yes No Attached
        Sire Name: Registration No.
        Dam Name: Registration No.
If already registered insert registered name and number below:
        ATA Reg. Name: Registration No.

I enclose the applicable fees and understand that I am additionally responsible for all equitable expenses incurred by the ATA in connection with the branding of my horse. I further confirm that I will not hold the ATA or its authorized representatives responsible for any damage or injury incurred or inflicted by or upon any person and/or animal or other property in conjunction with or resulting from the branding procedure.

        
          Date                              Signature of Recorded Owner

BRANDING REPORT BRANDING REP. USE ONLY

Date Branded: at (location):

I, _________________________________________________________________________________________________
(print name and address of branding representative)

Have performed the following:

seen the horse’s ATA registration certificate and confirmed that it is the horse described on the certificate:
believe the markings for this horse should be changed as follows
seen the dam’s official Stud Book registration certificate;
convinced myself above foal is indeed out of indicated mare;
confirmed color and markings of foal;
personally and properly applied ATA brand to left hip of above horse;
supervised proper application of ATA brand to left hip of above horse.

Remarks:______________________________________________________________________________________________
_____________________________________________________________________________________________________

__________________________________________________         __________________________________________________     Owner or Owner’s Agent                                                                                Signature of Branding Representative
    WITNESS TO BRANDING

1. Fill out form online
2. Pay the appropriate fees (using the Paypal button below)
3. Print form and give to ATA Branding Representative prior to branding of horse
4. Submit application electronically to the ATA (using SUBMIT button below)
5. Forward completed branding report, to:

AMERICAN TRAKEHNER ASSOCIATION, INC.
1514 West Church Street
Newark , OH 43055

• Branding Fees	Members	Non-Member
  License fee (one-time)	$50.00	$100.00
  Per Horse Branded	$60.00	$100.00

  I am presently a member of the ATA
  I am not presently a member of the ATA but I wish to join at this time

Membership choices: Active Member ($75.00) Lifetime Member ($750.00) Junior Member ($35.00)      
Fill out the ATA Membership Application and add appropriate fees to branding fees. Pay through Paypal or send check/credit card information along with this printed form to the ATA

Please print this form prior to submitting your online application and paying your fees. Thank you.

*Please select one of the following payment forms:
I will Pay Using Paypal I will call a credit card # to the ATA I am mailing a check