International Parrotlet Society
Cooperative Breeding Program Application
Breeder Information
Name:__________________________________________________________________
Aviary
Name:___________________________________________________________________
Address:_________________________________________________________________
City : ___________________ State : _______________ Zip
Code : ______________
Telephone Number : (_____) ______-_________ Fax : (_____)
_____-__________
E-Mail : ____________________________ Web-Site
:__________________________
IPS Membership Number : __________
M.A.P. Certification Number : __________
Address of the Breeding Facilities : ________________________________________
City : ___________________ State : _______________ Zipcode
: _______________
Facility Telephone Number : (_____) ______-________
Total Facility Space : __________ (in square feet / meters)
Facility Space to be allocated for CBP Use : ____________ (in
square feet / meters)
Cage size: Length ___ x Width ___ x Height ___ (in inches or
millimeters)
Nest box size : Length ___ x Width ___ x Height ___ (in inches or
millimeters)
Breeding Experience
Species of Parrotlets applying for : _______________________________________
(Complete one application per species)
Years experience breeding parrotlets :
____________________________________
Years experience breeding applied for species :
____________________________
Previous year breeding statistic information :
No. Breeding Pairs : __________
No. Clutches : _________
No. Eggs : __________
No. Fertile eggs : __________
No. Dead in shell : __________
No. Fledges : __________
Mail to:International Parrotlet Society
Post Office Box 2428
Santa Cruz, California 95063-2428
Sandee L. Molenda, Secretary (831) 688-5560
E-mail: IPS@parrotletranch.com
Please complete and return this form to the International Parrotlet
Society at the above-address. If you are approved, you will be notified by mail. Upon
receipt of your registration forms, completed and signed copies of the Management Group
Plan, CBP Agreement and payment of the participation fee you will be assigned and
sent a breeder code number along with forms to register your birds. This code will be used
to keep all the records on your birds with the CBP in order to keep your confidentiality.
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