AKC Genetic Diversity Project Kit Request Form

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* 1. Today's Date

Date / Time

Date

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* 2. Point of Contact Name

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* 3. Point of Contact Email Address

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* 4. Point of Contact Mailing Address (Please enter complete mailing address!)

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* 5. Point of Contact Phone Number

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* 6. What breed or club are you requesting kits for? Please provide specific details.

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* 7. How many kits would you like?

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* 8. What date do you need these kits by? (NOTE: Please allow one week per every 100 kits ordered.)

Date / Time

Date

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* 9. Click here to download the AKC GDP submission form. Submit one form per kit.