Name
Street Address
City
State
Zip Code
County
Home Phone Number
Work Phone Number
Email Address

Do you prefer a	Standard	Toy	No preference
Do you have a preference for sex?	Male	Female	No preference
Age Preference?	Under 1 yr	Young Adult (1-5)	Adult (5 yrs +)

(Please note that this is used as a guide only and there is no guarantee that AMTC can find you the dog of your preference - AMTC will still contact you if there is any rescue dog in your area)