Broodmare Conversion Form

The undersigned certifies that (a) he/she is the owner or authorized agent of the owner, (b) that the name and address of the owner is correct, (c) that the undersigned has full power and authority to execute and file this report and to receive any requested or related documents from the TTA, and (d) the information supplied on this form is complete and correct. The undersigned also certifies that he/she has read and understands the Rules and Regulations of the Accredited Texas-Bred Program and that he/she has complied with such rules.

Postmark date or Processed Credit Card Payment date will be considered effective date of breeding stock conversion.