Please fill in all the fields marked with *

About the puppy I want:

	Sex:*	Male Female Not Sure
	1st choice of color:*	White w/black Marble-black Solid Black White w/tan Marble-tan Solid Tan White w/brown Marble-brown Solid Brown Other Not Sure
	2nd choice of color:	My 1st choice only White w/black Marble-black Solid Black White w/tan Marble-tan Solid Tan White w/brown Marble-brown Solid Brown Other Not Sure
	3rd choice of color:	My 1st/2nd choice only White w/black Marble-black Solid Black White w/tan Marble-tan Solid Tan White w/brown Marble-brown Solid Brown Other Not Sure
	Specify if "Other":
	Additional specifications and notes:
	I am considering getting a puppy from:*	US only Canada only US or Canada only Russia only anywhere possible
	I am :*	sure that I want a Russian Spaniel and ready to buy just requesting information and not ready to buy somewhere between the above two choices

About me:

First Name: *	MI:	Last Name: *

	Address:	Street:
		City:*
		State:*	Select One: CANADA-NOVA SCOTIA CANADA-NUNAUVUT CANADA-ONTARIO CANADA-PRINCE EDWARD ISLAND CANADA-QUEBEC CANADA-SASKATCHEWAN CANADA-YUKON AK AL AR AS AZ CA CO CT CZ DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TT TX UT VA VI VT WA WI WV WY CANADA-ALBERTA CANADA-BRITISH COLUMBIA CANADA-MANITOBA CANADA-NEW BRUNSWICK CANADA-NEWFOUNDLAND and LABRADOR CANADA-NORTHWEST TERRITORIES
		Zip:
		Country:*	USA Canada

	Day Telephone Number:*	ex.:999-999-9999
	Eve Telephone Number:	ex.:999-999-9999
	Fax Number:	ex.:999-999-9999

E-mail Address:*

My plans for the puppy:

My dog will spend most of his/her time:*	in my home outside
I am planning to have my dog hunt with me or member of my family:*	No Yes
I am interested in training my dog for field trial and/or hunt games:*	No Yes
I would consider breeding my dog:*	No Yes

Here is why

I am interested in getting a Russian Spaniel puppy because...*
I found the Russian Spaniel Club through...*